


Feedback Loops

by J_Baillier



Series: You Go To My Head [10]
Category: Sherlock (TV), Sherlock Holmes & Related Fandoms
Genre: Alcohol Abuse/Alcoholism, Angst, Autism Spectrum, Autistic Sherlock Holmes, Bullying, Doctor!John, Doctor!Sherlock, Education, Established Sherlock Holmes/John Watson, Family Drama, Insecure Sherlock Holmes, M/M, Medicine, Miscommunication, Siblings, Teaching, anaesthesiology, neuroanaesthetist John Watson, neurosurgery, surgeon Sherlock Holmes
Language: English
Status: Completed
Published: 2018-09-03
Updated: 2018-09-24
Packaged: 2019-07-06 08:47:05
Rating: Mature
Warnings: No Archive Warnings Apply
Chapters: 8
Words: 40,680
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/15882633
Author URL: https://archiveofourown.org/users/J_Baillier/pseuds/J_Baillier
Summary: While John tries to deal with his sister, Sherlock is forced to take on a neurosurgical trainee.





	1. Roll Call

**Author's Note:**

> Though I am using the names of real London hospitals in the series, all characters/staff, internal politics and problems, research projects and so on are entirely fictional. I have no reason to believe that the professionals working at King's and The National are anything but highly trained, lovely, dedicated and treat each other well. 
> 
> (Negative) feedback loops are an important concept in endocrinology (a medical specialty focused on studying hormonal secretion and the affiliated organs). It means that a hormone being secreted in significant amounts down-regulates—in another word, inhibits—the production of more of itself by affecting the secretion of its own regulatory hormones. I'm sure Sherlock would love endocrinology; it has a bit of a reputation of being rather complex since it deals with intricate regulatory loops and multitudinous tiny details of human biochemistry. Neurosurgeons need to be familiar with at least some parts of it since the brain produces many of these regulatory substances.

 

 

 

> _I swear by Apollo the Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture._
> 
> _To hold my teacher in this art equal to my own parents; [--]; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath._
> 
>   
>  — The Hippocratic Oath

 

 

**_Feedback Loops — Chapter 1: Roll Call_ **

 

"Staff exit at five?" John asks, pocketing the car keys as they begin the walk from the staff garage to the hospital.

He receives a frown and then a nod from Sherlock. "I should have the DBS stimulator removal done by then unless the infection has disintegrated the whole thing to pieces. Thank god I won't have to operate with the patient awake, could be quite a mess in there."

Two neurosurgeons at King's College implant deep brain stimulators to treat various neurological issues and treatment-resistant OCD. Sherlock is not one of them; the procedure is not complex enough to have tickled his fancy, and at the meeting where the unit's DBS program was being planned, everyone had laughed at the idea of him doing awake craniotomies. To adjust the stimulator, the patient is awakened during the operation and the surgeon communicates with them as they operate to make sure no other areas than the target spots are being affected; brain tissue does not feel pain, but understandably being aware of what is going on can be a distressing idea for the patient and requires outstanding interpersonal skills from the whole team. Even though Sherlock wasn't interested in learning the DBS installation procedure, it still stings that he had been cast aside because of who he is.

His tumour operations sometimes do call for an awake craniotomy approach, and to his annoyance, Lestrade has told him that for those cases, he needs to pair-up with another surgeon, or have John do the anaesthetics. Since Sherlock would loathe discussing such an imperative with a colleague, finding a space in John's busy admin calendar for those cases is his only option.

 _'You'll never be a neurosurgeon, Holmes; the very idea of you doing any kind of clinical work that would involve discussing difficult topics with patients is preposterous_ ,' Cambridge's professor of neurosurgery had told him within earshot of a bunch of other trainees, who had snickered and given him snide looks as he headed out of the ATC4 lecture hall at Addenbrooke's Hospital.

Who the hell has the right to tell someone else what they can, or can't do? Isn't the very purpose of _training_ someone to teach them to overcome their particular challenges? Do teaching staff not understand the fragility of the confidence of their students? Shouldn’t they take more responsibility for the consequences of such throw-away comments?

_Idiots._

Thankfully, Sherlock had been able to obtain a recommendation letter from one of the other professors in Cambridge's renowned neuroscience centre—one who happened to have studied at Oxford with Mycroft in the same college. Sherlock would have preferred to get accepted into training with his own merits—he's against nepotism on principle because the result of it often is that the most competent candidates get side-lined—it was just that he didn't see many other options of getting where he wanted to be.

Once within the walls of the National, Sherlock watches John heading out of the main entrance hall and towards the Bessemer Wing. Just as John is about to grab a door handle, a young woman with a stroller practically crashes into both him and the door. She drops a bag and nearly the baby she holds in her arms. Her hair is a mess, she's laden with various other bags, and the infant in the stroller is now wailing and wide-eyed; the stroller is turned just so that Sherlock can see the tears and snot running down the face of the dark-haired child.

"Can I give you a hand?" he hears John interrupt the woman's florid apologies.

The mother drops what looks like a backpack on the floor and looks like she wants to hug John. "Thanks. It's been a bloody nightmare of a morning."

"Heading to the paediatrics unit?" John asks, then looks startled as it is the baby the woman shoves into his arms and not a bag.

The toddler in the stroller is still wailing, and Sherlock has to supress an instinct to leave, or to shut the noise out of his head by pressing his palms to his ears. 

"Yeah, Monet's got a check-up with our diabetes doctor, don't you?" she learns over the stroller and plants a wet kiss on the toddler's forehead before attempting to rearrange her things. This at least turns the screaming into a sorrowful snuffling.

 _Monet? Christ_ , Sherlock thinks, knowing full well the burden of being saddled with a strange first name. Well, he'd been called by the first of his three first names—William—for most of his youth, but it had never felt like _him_. He must have been destined to be a Sherlock, despite his parents' efforts to make him sound like everyone else. He _isn't_ like everyone else, so a strange name doesn't add much to the trials he has to go through which normal people can just sidestep.

He should be going since he is on ward round duty this morning— _boring!—_ which he needs to be done with by lunchtime because he's got a summons to go see Greg at noon, but he finds himself highly distracted by the sight of John holding the baby. John is saying something to it—Sherlock can't hear what exactly, but it looks vowel-heavy, possibly a nursery rhyme. He has grabbed the baby's chubby little hand and is swinging it back and forth. Sooner rather than later, he manages to coax a giggle out of the child who starts frantically kicking against his stomach. John pretends to get winded by this and the woman gives him an appreciative glance.

"Ooh, this one'll be a Beckham yet!" John exclaims.

Sherlock doesn't know what a Beckham is. _Presumably some brain-rotting children's TV series?_

The mother holds out her arms and receives her child back from John. "Thanks, you're a star."

John then helps her arrange the rest of her bags on the stroller and on her shoulder.

She glances at the wall clock behind them in the main hall. "Shit, we gotta run. Have a good one!"

John holds open the door for them, and walks down the corridor after the troupe, soon disappearing from view.

Sherlock, however, is frozen in place, because an epiphany has hit him like a freight train. Why has it never occurred to him to ask this question before? He had always assumed it was something to be dealt with in the future, but John is approaching the age of forty. Surely, he has considered the topic by now. Had he discussed it with Molly, his therapist? Why hasn't he raised the subject with Sherlock? He wants to kick himself for failing—yet again—to realise such an obvious, important issue needs to be addressed. Because it has to do with relationships, despite John's assurances that he does fine in the one they are in, Sherlock knows that this is his weakness, his deficit that he cannot make sense of such matters without someone explaining them to him.

And, now he's gotten lost in self-loathing instead of addressing the actual question. Which is— _obviously—_ this: does John want children?

 

-o-0-o-0-o-0-o-0-o-0-o-0-o-

 

John is just about to grab his jacket and head down to the cafeteria for a working lunch with the head of the acquisitions committee. The purpose of their rendezvous is to see about getting new anaesthesia workstations in the trauma ORs. He's just about to push open his office door, when his mobile rings.

"Hey Greg. I was just about to get some food."

"Never mind that. I'm going to need your glare in five minutes."

"Excuse me?"

"I need that glare of yours, you know, the one that always keeps him from throwing a hissy fit."

John sighs. It's becoming rarer for people to request that he do a bit of Sherlock-whispering, and he really shouldn't reinforce the idea that such a thing is even needed, but if Greg Lestrade, the head of neurosurgery, requests his help then shit must be truly about to hit the fan. "What's up?"

"You know that this year's Match results have come through, don’t you?"

"Of course."

"Due to that one weirdo last year who kicked up a fuss when we showed him the door, we're facing an inspection this year from the GMC over training conditions. To show them that we're a fully functioning training unit we need everybody on board with a maximum number of registrars and SHOs under their wing—and I do mean _everyone_."

John grips the phone tighter. "Greg, _no_."

"That would be _Greg yes_ , I'm afraid." His colleague sighs. "Even Sherlock."  
  


-o-0-o-0-o-0-o-0-o-0-o-  
  
  


"We had an agreement!" Sherlock snarls, slamming his palms on Lestrade's desk. "My time is too valuable to be wasted with fumbling idiots. The deal we made was that, as long as I agree to run the ward on two days a week, I will not be obligated to put up with––"

"––interns and junior doctors. I remember. But, proper neurosurgery registrars and fellows are a different matter, and I need all hands on deck," Greg argues while John watches the proceedings from the doorway, arms crossed.

The occasional medical student teaching round at the ward is bearable, as long as Sherlock doesn't have to get to know any of the students beyond glancing at their name tags. When he's in a good enough mood, he might even whip up a mini-lecture on whatever his brain has latched onto recently, and it's nice to bask in the limelight for a moment. A medical student is in sufficient awe of any proper doctor, that they are positively star-struck by him, which helps them ignore his faults. On the other hand, FY1s and FY2s—meaning relatively newly graduated doctors—are not a good fit to be taught by someone who has no patience and no understanding for those inferior in intelligence and skill, never mind that everyone has been a beginner sometime. Trainees shouldn't be allowed near him; he doesn't want to inadvertently say something that will feel as crushing as the things he had been told early into his career. Someone with more finesse and skill in being tactful and supportive needs to handle such matters. Not him.

It irks him that Lestrade has summoned an audience. Everyone always assumes that John's presence is like a tranquiliser dart for him, making him malleable. "Registrars and fellows can be perfectly well trained by the average neurosurgeon the peak of whose career involves bread-and-butter cases. You don't need me to show these people the ropes, unless you want me to inadvertently hang them. It's a waste of everybody's time."

"I don't have a choice. The Board has to deal with the upcoming Royal College inspection, and the notion of a consultant deemed unfit to teach might undermine our education funding."

 _Unfit_. For once, Sherlock agrees with his boss.

He crosses his arms, a frown twisting his forehead into a furious landscape of dismay. "Then make it temporary. Hire some locum you can parade in front of the Royal College brass and kick them out after the inspection is done."

John sits down at the edge of Lestrade's desk, presumably to form a unified front. "They do inspect the trainee paperwork. They'd spot that little dodge very easily."

Sherlock wants to protest some more, but that would lead to question starting with the word 'why', and he isn't willing to talk about why it's just a knee-jerk response for him to refuse.

Maybe the only way out of this is to sacrifice one trainee to demonstrate what a disaster Lestrade and John by extension are insisting on cooking up. _Let them see._ Let them all see what happens, when someone's career is put in the hands on a single person, and that single person happens to be him. He doesn’t want the burden of having to monitor everything he says. There are no scripts to handle the situations training someone would land him in, which is why he has always avoided it until now. If they are stupid enough to disregard his warning, then they get what they deserve.

So, he huffs and squares his shoulders. "Then, at least give me someone adequate."

Greg digs out a pile of applications carefully organised into a fan shape.

John is frowning at Sherlock, probably surprised at how quickly he had yielded. This will reinforce John's thinking that his presence can keep Sherlock from blowing a gasket.

Maybe it does.

"You get first dibs in picking one," Greg placates.

Sherlock shoves the papers around until he finds the thickest manila folder. He leafs through it and then shoves it into John's hands. "This one, then. Perfect Match score, thrice the number of recommendation letters compared to the other applicants, two research papers published in reputable journals. Can't be _entirely_ incompetent." This trainee looks like someone who just might be able to walk away unscathed once this stupid arrangement implodes in everyone's face.

Greg spreads his arms. "Fine. I'll also need you to pop into the morning assembly on the first day of the induction week," he says with a strained expression, probably preparing for another argument with his moody star consultant.

"What on earth for?"

"It's a show of solidarity, a welcoming gesture of us all being there to meet with our new trainees."

"You have blackmailed me into dealing with one trainee; I see no reason to waste time the others. And, as you and I already know my _colleagues_ are never exactly happy to see me."

"Think about how you would have liked to be treated during your first day as a neurosurgical trainee. If the person you were assigned to never showed up, you’d have felt embarrassed. "

"I didn't need mollycoddling, welcoming gestures or an _induction week_. They should be proving their worth to us, not the other way around," Sherlock argues, arms crossed and eyes narrowed in his usual posture of high-calibre scepticism.

"Monday the fifteenth August at 7:45 at the smaller basement lecture hall. That's an _order_."

Sherlock huffs, and marches out.

 

-o-0-o-0-o-0-o-0-o-

 

"That went well," Greg comments bitterly to John while shaking his head. "Should we give this future reg of his The List?"

John shakes his head. "I don't even really approve that they give it to the new nurses."

The List, also known as the Holmes Codex, is a collection of pointers for those previously unfamiliar with Sherlock's preferences and demands. The collection of lore includes clinical pointers, a schedule of Sherlock's usual weekday routines, his tea and coffee and instrument and glove preferences, a list of acceptable and unacceptable music choices, and random notes on preventing getting shouted at in the OR or chewed out on the ward rounds. The last piece of advice on the list says: _'When all else fails, call Clinical Director of Operative Services John Watson_ '.

In John's opinion, it shouldn't be acceptable in this day and age that nursing staff would be exposed to the shenanigans of a moody surgeon, but even the hospital Trust Board has been willing to make certain concessions to keep their neurosurgical star happy. One of them has been that he is allowed to shirk the duty of having a Specialist Trainee on his service.

What irks John the most is that he has heard corridor rumours that he had been the one to condone the existence of The List, since he's Sherlock's partner. Some people even think he _wrote_ the damned thing. It doesn't exactly help that Sherlock is not above using his name as leverage when he wants to crunch a decision through the slow wheels of hospital bureaucracy. John has been trying to encourage him to sort out his own issues—to finally take full responsibility over even his most problematic patient interactions. They’ve been through a lot over the past year, what with his injury in Afghanistan and then Sherlock’s incarceration in the halo when he’d broken his neck; they have both had to learn a lot and adapt, so he knows Sherlock is perfectly capable of picking up new interpersonal skills. Their relationship now feels stronger than ever, and Sherlock seems to be more willing recognise his need to adapt to changing circumstances. Maybe this registrar training thing could be the an important step on that road? Stepping into an educator role might teach Sherlock quite a few things about human interactions.

The new House Officers and Specialty Registrars start their training years on 15th August, but their first week will be spent in the inductionGreg had mentioned, which means introducing them to the Trust they will be working in and making sure they have the requisite knowledge and skills to make it through their rotation. That's still a month away; there's plenty of time for Greg to try to hammer into Sherlock's brain that since someone had gone through the considerable trouble of training him, he should pay that debt back in the spirit of collegiality by training someone himself.

John is torn. He knows that Sherlock doesn’t give a toss about educational philosophy or tradition. He never hides his deeply negative ideas about the current training paradigms, and sometimes John wonders what lies beneath all the venom that oozes out of his diatribes on the subject. His arguments are often vague, and he tends to clam up when John asks why he has such a personal beef with the system. Pushing him into this could help him come to terms with those issues—or might just make them even worse?

John peruses the folder which Sherlock had shoved into his arms. Within a minute, he whistles: "Plenty of glowing reviews. Outstanding exam and application scores. And, this poor girl has even specially requested to be assigned to Sherlock for some reason."

Greg leans closer to have a look at the application form John is holding. "Sherlock's right—she's clearly the best of the bunch. We'll just have to hope it's enough to survive _him_."

 

 


	2. A Warm Welcome

 

Three weeks later, Sherlock slams the cab door after arguing about the fare. He had insisted the cabbie take an alternate route to avoid no less than three noisy road works along the shortest course between King's College and West Brompton, but the man had refused. That had got them stuck in traffic for an extra twenty minutes, and Sherlock had announced that he wasn't going to pay for that wasted time since his sound advice had been ignored. He should have guessed that the result would be nothing less than a threat to deposit him at the nearest police station.

Thank heavens—and John's driver's licence—that most of the time he doesn't have to deal with public transport.

He gives a nod to their retired cellist neighbour on his way up. The man lives right above him and John. As a result, he had heard bits and pieces of Sherlock's violin practice from downstairs and had once even complimented him on his Haydn the next day when they'd passed each other in the hallway. As neighbours go, the man is bearable.

Sherlock yawns as he strides up the last steps to their landing then stops to check the floor number painted on the wall because someone is standing in front of the door he had assumed was theirs. He _is_ on the right floor, and recognition eventually dawns when the person who's taken over half the landing with old, tattered suitcases turns to face him.

"Harry?"

"Where the hell have you been?" Harriet Watson asks with a disapproving tone. "John said you're off work today."

"I was on call, after which I gave my handoff report to the ITU day personnel and the colleague in charge of the neurosurgical ward and sorted out some paperwork. I didn't know to expect you so that tone is hardly warranted." He is not in the mood for visitors after operating for most of the night, especially not surprise ones. Then again, when has Harry ever planned anything ahead?

The smell of stale liquor flirting with hangover sweat floats into his nostrils when he steps past Harry to open the door.

"You gotta give me a hand with these," she tells him. "Cabbie wouldn't carry any up, thank God for one of your neighbours who didn't complain when I took over the lift for a while and even helped me out a bit."

"This looks like half your belongings," Sherlock comments, dismayed. Why hasn't John given him any warning about her coming to stay?

It isn't that he dislikes John's big sister, but he can't admit to being very fond of her, either. He prefers that John deals with her without any input from him. And right now, after being on-call all night, his patience level is severely depleted by the idiot colleagues who’d kept him awake and busy even after his OR duties ended because they couldn’t be arsed to make their own decisions.

"More like all of them," Harry scoffs bitterly and shoves one of the bags into the flat after Sherlock, who had grabbed one of the bigger ones.

The guest room seems like a logical place to put all of it. After they're done, Sherlock sheds his coat, frowns at Harry's weather-inappropriate denim jacket and points to the kitchen.

"Tea?" John would want him to offer, wouldn't he? Perhaps, over a beverage, Harriet could explain why she has come to darken their door.

"She chucked me out, didn't she?" Harry wastes no time in announcing. "I came home and found my stuff on the kerb. Who the fuck even does that, except in the bloody movies?"

"This would be... Julie?" Sherlock guesses. No one should be expected to keep up with Harry's human carousel of girlfriends.

"Clara! Jesus. John got it wrong, too. You two still such workaholics that you can't remember a thing that happens to anybody else?"

"I remember everything _relevant_ that happens to other people," Sherlock mutters while digging around a cupboard for the cheaper Assam. "Why that should include the name of a person I have never met seems peculiar."

Standing with his back to the kitchen island, Sherlock then digs out his phone from his jacket pocket and covertly texts John.

**Message from SH at 11:47: Thanks for the warning.**

An answer comes almost immediately.

**Message from JW at 11:48:** **Sorry she was in the cab already when tried to phone and then texted. I was in a meeting and only picked it up twenty minutes ago.**

Sherlock puts the phone on the breakfast bar, sighing. "I assume you need a temporary residence, then."

"If it's not too much trouble," she replies with an entitled smile, grabbing a HobNob from a packet John had left on the island. Her tone implicates that her presence causing any issue is a sheer impossibility. "You don’t seem all that thrilled by me being here."

Sherlock plasters a fake smile on his face. "I’ve just got home from being up all night, so you will have to overlook the fact that I am not charm personified."

"I like what John's done to the study; he’s made it into a nice bedroom," Harry then compliments.

Sherlock turns to face her as he places two mugs on the counter between them. "That was me."

"Oh."

He takes in the sight of her as she curls her thin fingers around her steaming mug. Her shoulder-length hair has at least seen a hairdresser's scissors recently, but it still hangs in dull, sweaty locks, and the colour is faded in a way that suggests it comes from a supermarket packet. Her face looks slightly puffy but not as though she's been crying; the staple of a female alcoholic that makes her look much older than her years. Jeans: a flattering cut with a reasonable fit. Sweater: decent high-street brand but worn and baggy, probably to hide the extra doughnut of weight she has gained after Sherlock has last seen her. Dark shadows under her eyes do nothing to compliment her sallow complexion. Her mascara is flaking onto her cheeks, but then again, it always does. Probably some cheap brand. She manages to appear to be both slightly drunk _and_ sporting signs of a morning after.

Sherlock has never seen her sober. Always either inebriated or thoroughly hung over, and neither of those states makes for pleasant company. When drunk, she tries to be overly friendly but ends up teasing him mercilessly. When hung over, she tries to give him relationship advice which he neither welcomes nor believes, coming from someone who is even worse at this stuff than him or John. If she'd come over straight from Clara's flat in Elephant&Castle, she must have come home in the morning, presumably from an all-nighter at a bar.

She digs out a phone, too, and puts it on the kitchen island with the screen facing down. It's old, scratched, but had once been quite an expensive model. Sherlock leans closer and tilts his face to see the inscription on the customised cover in a muted metal shade: ' _Love, N xxx_ '.

"That was John's. Gave it to me after he got home from Afghanistan the first time."

 _Ah. N for_ _Natalie Templeton_. Since her and John's relationship had gone through palliative care in the form of John invading a foreign country, it's logical that he wouldn't throw away such an expensive item but would want to be rid of it all the same. John tends to be somewhat frugal—courtesy of a childhood where money was very scarce.

To his slight surprise, Sherlock discovers no bitterness in himself after being reminded of John’s ex. Once, he had believed that what John had done to end his and Natalie's relationship was about to repeat itself with him, but that had turned out to be a false assumption.

She checks the phone screen. "Nothing."

"I assume you have offered your default apologies, then."

She gives him a dirty look. "You're such an arsehole."

He takes no offence. Coming from Harry, such statements are half-endearments. John does the same, call him git or berk with exuberant fondness. In fact, the only things Sherlock likes about Harriet Watson are her directness and honesty—which, unfortunately, extend to everything else but her alcohol abuse problems. No self-awareness or insight whatsoever, just plenty of stubbornness. Sherlock has refrained from commenting on Harry's addiction issues to John, even when John laments about her drinking to him. He has his own past to carry and doesn't want to sound holier-than-thou.

"What's the plan, then? I assume you'll be wanting to speak to a housing agent as soon as possible."

"So that you can then throw me out, too?" she teases.

He says nothing. He knows it's customary to give aid to a spouse's close relatives but, given her general long-term level of responsibility and initiative, she'll need a shove forward if he's to prevent her from taking up a semi-permanent residence in the guest room.

"I'm sort of between jobs. Clara was paying the rent. You got anything stronger?" she asks, shoving her half-drunk mug at him across the table.

"It's barely noon."

"And I've just been dumped, so shut it, Sherl."

Sherlock bristles. Nobody calls him that, not even John.

She wrenches herself off the barstool and goes straight to the corner cabinet where John keeps the whiskey. She upends the leftovers of her tea over the sink, then pours into the mug more than a few fingers of Glenfiddich before clinking it against Sherlock's. "To new beginnings, eh? I heard you and John are doing great, again."

Sherlock has no idea how much John has told her of the events of the past year.

"I'm glad. He deserves it; he works so hard. He still seeing that therapist?" Harry asks more cheerily than someone drowning the sorrows of being rejected should.

Sherlock manages to suppress his rising annoyance by reminding himself that as this is John’s only living family member, so it's not unexpected that he'd share such details with her. "Yes."

Harry digs out a packet of cigarettes from the back pocket of her jeans. "You got a light?"

"You should go to the balcony; John'll have kittens otherwise." He does open one of the top drawers of the breakfast bar to rummage around for a lighter. John calls it their crap drawer, and it irks Sherlock that there is no logic to its contents.

Harry waves the Mayfair packet at him. "Join me?"

"I've quit."

"Nobody _really_ quits smoking."

_Just like nobody really quits drinking?_

Sherlock detests such thinking. He has never identified with AA's ' _once an addict, always an addict'_ in the sense that if he isn't using, he doesn't want to tie his identity to it. He's very willing to concede that such therapeutic approaches might work for many people, but he's not the average person, is he? The rehab Mycroft had sent him to employed a much more rigid regime mostly based on the fact that in the middle of the Scottish wilderness, dealers weren't exactly hiding behind every bush. That, combined with the fact that he'd discovered medicine and decided he wasn't going to spend his life going down the same road as Victor Trevor, had been the thing that helped him get clean and stay that way. Well, _mostly_ stay that way.

"John knows I've quit."

Harry snorts. "I wish _I_ could quit just to make someone happy. That doesn't last."

 _The quitting or the happiness?_ "As I said, John would prefer that you smoke outdoors. Now, if you don't mind––I _have_ just been on call." He refrains from saying that he would also prefer that Harry indulges on the balcony—the smell of the smoke might become a huge temptation for him. When off call, especially after a taxing shift, the desire to smoke can be almost unbearable.

Harry drags herself off the chair and heads for the balcony. "I'm fine right here. You go shower or whatever."

A nap is what he'd been planning, but with a half-stranger in the house, he won't be able to fall asleep.

After he emerges from the shower twenty minutes later, he hears Harry banging about in the guestroom, probably unpacking. The racket quenches whatever remaining hopes he might have had about getting some rest.

When he goes to the kitchen to find a pair of scissors to remove a label from a packet of new socks, the whiskey bottle sits on the counter, now empty.

  
  
-o-0-o-0-o-0-o-0-o-0-  
  


August arrives.

Not only is Lestrade making Sherlock attend some inane introductory assembly, but now he has also been tasked with giving a short presentation about their unit and what is expected of the new Senior House Officers, Foundation trainees, Specialist Registrars and Fellows who have taken over the smaller basement lecture hall of the Ruskin wing. Only the fellows and SpRs are actually being trained as future neurosurgeons, but the daily running of the unit requires more staff, and a rotation in neurosurgery is seen as a potentially beneficial bit of training in many other specialities.

The air down at the basement lecture hall is always stuffy and makes everyone yawn, especially at eight in the morning. Sherlock would much rather be sitting in the break room of the surgical floor reviewing his procedure notes and preparing to scrub in. In fact, he’d even prefer to be handling Ward duty or managing one of his clinics to this induction thing.

It’s not the lecturing that bugs him. He has never been nervous about public speaking, and that's not about to change today. Whenever he has had to give a presentation in medical school or to colleagues at M&M meetings or scientific assemblies he has done so with thorough notes, an extensively rehearsed verbal script, his facts well-backed by recent research.

This is different. Giving advice about how to survive the first weeks as a trainee at King's College's surgical units is hardly something that can be researched at PubMed.

"Just tell them what you'd expect of them," John had told him at home when he had lamented this stupid task.

That is exactly what he shall do. No need for powerpoint slides, is there?

"Sherlock Holmes, one of the consultants who will be taking on a Specialist Registrar, has kindly agreed to give you all a bit of advice on how to make the most of your time here," Lestrade tells the audience, then nods at Sherlock.

 _Kindly_. _Ha bloody ha._

He rises to his feet, tugs his jacket lapels straight and joins Lestrade behind the microphone. The senior surgeon adjusts it to match his height, gives him an encouraging smile and goes to sit in the first row.

"Good morning. I assume you have already been put through some asinine name-learning exercise devised by some backwater psychologist to promote team spirit. That's what they did to us at the National back when I began my training, and I doubt the world has evolved since."

There's a slight chuckle from someone in the third row.

"I wouldn't worry about learning each other's names since it is highly likely many of you will be gone by the end of the month, or at the latest, the end of the year. Do not think for one second that this is some cosy placement with endless gossip over tea with the nurses in the break room—as surgical trainees, not only will you be expected to see to ward duties and to study the requisite theory, you will also need to show initiative in clocking enough OR hours to learn what it is you are here for—operating on people. Knowing the bare minimum to get by is not enough—believe me when I tell you that the profession of surgery is already riddled with mediocrity. Wanting to train at King's and not wanting to be the absolute best is a waste of both your time and ours."

He scans the audience. Some look a bit shellshocked—what had they expected? This isn't a nursery school. At least he seems to have their attention.

"If this field interests you—I say if, after seeing many trainees who are here merely because whatever useless placements they had actually wanted were snatched up by more competent people. _If_ this field interests you, you should have enough internal motivation to read everything you can get your hands on. Only if I see one of you showing actual promise, will there be a place and a scalpel for you in _my_ OR."

Lestrade is looking dismayed. Sherlock pauses a bit, wondering if he has misunderstood his brief. _Is it something I said? Or, not said?_

Perhaps he should aim for more practicality. "Senior House Officers are best barely seen and not at all heard. Do your charts and your obs and the bloods, all of it with legible handwriting, and you will be blissfully ignored by me. Foundation year trainees: harbour no illusions about your role—until you are proper SpRs, and maybe not even then, you may work in neurosurgery, but you are most decidedly _not_ competent in any aspects of it. Assisting in the OR is a privilege, not a right, and not one I hesitate to rescind. Registrars: all this applies to you, too, especially since you should have already learned at least _something_ useful. Fellows; please note that since I have nothing to do with that pseudoscientific fellowship program run by that idiot Jones-Matsuda, do _not_ bother me with questions regarding those patients."

Lestrade looks stupefied, and as though he's about to launch from his seat back to the podium. He gives Sherlock a glare he knows means the equivalent of _shut the hell up_.

Sherlock clears his throat. "Right. Well. Do enjoy your time at King's is what I am certain my colleague here would insist I say. Instead, I would much rather point out that while medicine can be both enjoyable and fascinating, you are not here to have fun."

Lestrade springs to his feet, strides to the podium, and moves the microphone away from him. "Any questions?" he asks with a smile Sherlock recognises as apologetic.

A young man with a cheap, ill-fitting navy polyester suit and a large cleft between his upper front teeth puts up his hand.

"Yes?" Lestrade asks eagerly.

"Do we get lunch coupons and is there space available on Mister Holmes' research team?"

Lestrade blinks, as though it is entirely fathomable that someone would ask about lunch coupons right now.

Sherlock agrees, which is why he leans closer to the microphone again. "What research team would that be?" he asks; "I do all the work myself, which is way too complex and important to be allocated to the likes of someone with very little understanding of engineering or neurosurgery, a description likely to apply to every single one of you."

Lestrade growls his name quietly and gives him a shove with his elbow. Apparently, he is to go back to his seat.  _Gladly_.

A coffee break is announced, after which Lestrade wastes no time in dragging Sherlock to the corridor by the elbow.

He tugs his arm out of the senior surgeon's grip and gives him a scowl.

"What the hell was that?" Lestrade demands. "Too much to ask, is it, to just say welcome and a few encouraging words?"

"I have always found honesty and realism rather invigorating, myself."

"You think any one of them will want anything to do with you after this?"

"I was rather hoping they wouldn't."

"Sherlock… We do have to train them. If we don't, there'll be no one to do this job after we retire."

"I don't care about what happens after I retire. Which I do not mean to do until I become physically unable to operate."

"Someone trained you, too, you know. Time to pass on the baton."

"You have a large crew of other neurosurgeons. I shouldn't be in charge of anyone's training. I _can't_ be given any responsibility for it, it's––" he trails out, realising he has already said too much.

"One of the juniors in the audience is your new SpR."

"I'm not stupid—I was perfectly aware of that. He now knows what's expected of him."

"She."

"He, she, what does it matter? I won't be judging her based on her gender attributes—only her performance."

"You're not going to be _judging_ her but training her. She's done ST5 already, so there's just the more advanced stuff she needs. She scored very high in her MRCS," Lestrade says.

It's pointless how the man is trying to sing this trainee's praises. Sherlock does not need reminding about the Royal College major exam every neurosurgical trainee now has to take before being accepted into third-year speciality training. Unlike in many other surgical specialities, neurosurgical training starts right at year one after graduating from medical school instead of several years spent doing more generalised core rotations.

Sherlock had still been wishing he could circumvent this whole training endeavour, hoped that his speech this morning would make the person expecting him to interact with them to request someone else. He doesn't want to train anyone, he simply _can't_ … It shouldn't even work like this. It's not good for any single senior colleague to become too important for a trainee. The training system is broken, and he wants nothing to do with it; the reforms that have been made since his day have done nothing to address the main failings of the system.

He bites his lip and looks at the wall, trying not to remember the day they called him into the Program Director's office at The National Hospital for Neurology and Neurosurgery. That day he found out that he had been flung to the wolves, alone. It wasn't anyone's fault but his own, how things had gone, but the system is still broken, and he wants nothing, _nothing_ to do with it. It is too heavy a weight knowing how great an impact he could have on someone. He's not cut out for this, he really shouldn't––

"Sherlock?" Lestrade asks, "Lord knows you're always stubborn about everything, but this can't be that bad. Just give her a chance. Who knows, maybe you'll get along and maybe she's one of the good ones. Someone worthy of your attention."

Sherlock pivots on his heel and walks out. Nobody gets it, why this is a disaster, and he doesn't want to explain it to them. The problem is not whether there exist trainees who would be worthy of his instruction—of course, there are. He's hardly the only good neurosurgeon in England.

No; the problem is whether it's fair for anyone to be stuck with him.

   
  


**Notes for the Chapter:**

> There is quite a lot of British medical training-related vocabulary in this chapter; some of it is outdated and some of it current. I have combined old and new for a bit of an artistic flair. Here's [a useful comparison chart](https://en.wikipedia.org/wiki/Medical_education_in_the_United_Kingdom#Specialty_training_and_postgraduate_studies) of the current and previous speciality training systems.
> 
> Neurosurgery differs from that in some ways; a thorough explanation can be found in [this BMJ article](https://www.bmj.com/content/338/bmj.b1123). If you look at the list of subspecialties you'll notice that Sherlock's work seems to encroach in the territories of several of them; paediatric neurosurgery, skull base surgery and neuro-oncology. There are. of course, occasional cases thrown in that can be found on the list of things in the article that every neurosurgeon must be able to manage. 
> 
> Someone who has finished ST years 1-5 is already quite competent in the practical basics of the field and now needs to move on to learning about the subspecialties. 
> 
> What's happening in the lecture hall is part of what is usually called an induction week: an introductory 'course' run for arriving trainees that is designed to help them adapt to the particular practices of the healthcare unit.
> 
> I don't work in the UK nor have I trained/studied medicine there, so it's best that we chalk up any mistakes or discrepancies in my descriptions of UK medical training and the NHS up to artistic licence...


	3. The First Incision

 

Three days later, John makes a brief morning stop in his office on the administrative floor after a meeting. After lunch, he is scheduled to oversee a new registrar's first steps in the OR since their assigned consultant is on sick leave. When he arrives on the fourth floor, he finds a young woman standing in the hallway looking like she's searching for someone. She is dressed sharply in a black business suit, her hair in a ponytail. Its blonde shade is natural, greyish and not very bright.

"Can I help you?" John asks with an official smile he effortlessly summons.

She turns to face him. "Morning. I'm looking for––" she consults a sheet of paper she digs out from her pocket "––Greg Lestrade?"

John has an epiphany; it's the start of rota day for anaesthesia trainees, so the same must apply to new neurosurgical juniors, too.

"Sure, follow me." John leads the way to Greg's office.

It turns out to be empty, but the door is open. "He can't be far, probably stepped out to get some tea," he explains and extends his hand. "John Watson, Clinical Director."

"Alice Lowe. Specialist Registrar in neurosurgery, as of this morning," she says. "Nice to meet you." Her accent has a hint of Scottish heritage, her grip is firm, and she looks very calm and composed.

 _She'd better be_ , John thinks, _since she's Sherlock's new trainee_. He wonders what she has heard about the unit and his assigned consultant during the two evening get-togethers that always happen at the start of the induction week. Last year's registrars had, apparently, attended in large numbers, so if Alice had not opted out of the social programme, she might already be well-versed in the current contents of the rumour mill.

If she knows he's talking to the significant other of his supervising surgeon, she refrains from commenting. Their relationship is hardly a secret, but John doesn't advertise it any more than any other couple with both halves working at the hospital would. He's in a senior executive position, which is all the more reason not to underline their involvement, especially considering the difference in seniority level between them.

As predicted, Lestrade returns soon, and John leaves the young physician to discuss practicalities with her new boss. Before he steps out of the office, however, he offers to take her down to the OR floor after they are done talking. He was going to meet Sherlock for lunch anyway, and this way he could introduce her to the anaesthesia staff. She'll be doing both neurosurgery and general surgery —the latter when she's on call—call as part of her training, so it won't hurt being introduced to all key staff as soon as possible.

Mostly, though, John wants to see how she hits it off with Sherlock.

Just as he's about to head back downstairs with Alice in tow, his phone makes a quiet buzz in his desk drawer where he'd left it set on silent.

**Message from Harry: Lend me a few quid tonight? Pete got my passport from C got to see him in Soho**

John has no idea why Harry needs money, who Peter is, or why they have to meet in where she usually heads out to party. Of course, she needs her passport, but this wouldn't be the first time she cooks up some convenient excuse to squeeze money out of him which will then go literally down the drain. "You've got plenty, and you're not even close to using all of it, right?" she had once said to John, eliciting an eye roll from Sherlock. "Not everyone's got doctors' pay." Clearly, she hadn't had any qualms about letting Clara—a barrister—pay for everything, either. This is one of the things John most dislikes about his sister: her sense of entitlement to what everyone else has. He likes to think he has made his peace with her problems; that he doesn't encourage her to be irresponsible, but isn't unsupportive, either. He just wishes that one day she'll stop relying on others to cushion every blow and to finance every breakup. He doesn't mind her staying at their flat—Sherlock certainly does but has not made a massive song and dance about it _yet_ —but John does wish she'd get on with things. It's promises after promises, which then get tossed right out with the next drink. She keeps using her breakup with Clara as an excuse to not even think about what comes next.

John does love his sister, of course he does. They survived the sort of childhood together that creates bonds stronger than even army service. But, she's always had an even more intense long-term relationship in her life: booze. At least she had skipped the apparent antisocial personality disorder and mean streak. John bitterly regrets admitting to her last night that he'd drank quite heavily after Afghanistan. Naively, he'd thought that maybe it might make her feel better not to be _the biggest living fuckup in the family_ , as she likes to phrase it. They have the same genes, so John knows he probably has a significant risk for addiction, too. Harry's had some successful periods of sobriety, usually at the start of a new, promising relationship. She can be quite the charmer; her last five girlfriends have included a barrister (Clara), a human rights lawyer (Jo), an artist (Julie, probably) and a highly sought-after dressage coach (John has no idea about her name; they'd never met). He loves seeing her happy but is getting tired of playing devil's advocate—reminding her when she hooks up with someone new to be careful and to stay off the booze if she wants the past not to repeat itself.

"Way to rain on my parade, Johnny, Jesus," she had told him when she'd introduced Clara over a restaurant dinner, and this latest conquest of hers had popped into the ladies'. John had told him not to mess this one up; he had liked Clara instantly.

He'd been right. He hates being right when it comes to Harry.

**Message from John: Take the tube and don't drink.**

He shoves the phone in his trouser pocket, not wanting to see what her attempt to guilt-trip him into changing his mind will be this time.

"I'll show you to the neuro OR floor," he tells Alice, who has just emerged from Lestrade's office as in peering into John's looking expectant.

 

-o-0-o-0-o-0-o-0-o-  
  


John gives Alice a short tour of the main features of the Neurosurgical theatre unit, after which they find Sherlock in the main corridor, conversing with Laura Arthur, one of the hospital's trauma orthopaedists.

John drops a hand on his shoulder to get his attention. Sherlock turns, and at first, a smile begins to creep onto his features as John comes to view. Then, his gaze flits to Alice, and when realisation dawns, he squares his shoulders which makes John drop his hand, folds his arms behind his back and clasps his left wrist with his right hand. All traces of delight instantly evaporate and are replaced with an angry, evasive distance.

"This is––" John starts.

"Black, two sugars but none of that white stuff, ask for the small packets of demerara the cafeteria idiots hide under the counter," Sherlock steamrollers in and then pivots on his heel to return his attention to his earlier conversation partner, only to be startled by the fact that the woman is no longer there. Visibly reluctantly, he shifts his focus back to John.

"Alice Lowe," Alice says, extending a hand.

The gesture is ignored. "I am perfectly aware of your name from your paperwork."

Alice is looking at Sherlock with a mixture of excitement and trepidation on her features. Eventually, she retracts her hand.

"This is your new registrar, not a waiter," John says pointedly.

"She is free to get herself a coffee as well," Sherlock offers coldly. "And I want the Mars bar you've got in your jacket pocket," he tells John.

"I thought we were having lunch together," John reminds him.

"An idiot rep made me waste half of my break already, and you're _late_ ," Sherlock replies. He hadn't been in a good mood this morning, having received a rejection from a scientific journal for his article the night before. He'd literally kicked John out of bed for snoring, then locked himself on the balcony to smoke.

John hates the fact that he is smoking again. With nicotine patches, he is much calmer in the OR as compared to the antsiness that ensues when he isn't able to sneak out for a smoke during more extended operations. He was supposed to have quit but, according to Sherlock, Harry’s presence has put paid to that. He had explained that, even if her presence wasn’t enough of an irritant to drive him back to the cigarettes, then the smoke fumes that cling to her skin, hair and clothes provide an ever-present trigger to his nicotine receptors. This is yet another thing he should act responsibly about, but doesn't, so John nags and gets a headache, and Sherlock does what he bloody well pleases.

It's clearly not a good day for new people in Sherlock's life, but it can't be helped. Induction is over, Alice is here, and they're just all going to have to play nice.

"Hungry?" John asks Alice.

"I brought leftovers," she answers politely. "I left them in the locker room fridge."

"Can you find your way back there?" John asks, and she nods. Sherlock is staring at them, emanating dismay. He's probably still expecting someone to fetch him his caffeine fix.

"What have you got on this afternoon?" John asks him.

"A rather pedestrian stereotactic biopsy. You may observe," Sherlock tells Alice, who nods eagerly.

John catches an aborted eye roll from Sherlock and makes a mental note to drop in on the afternoon's operation to see how things are going.  
  
  


-o-0-o-0-o-0-o-0-o-0-o-0-o-

  
  
Thankfully, the new anaesthesia registrar seems to know what he is doing, so after anaesthesia has been induced, the patient flipped onto their stomach for the back operation, and the position finalised, and everything checked and re-checked, John is confident enough in things going fine that he leaves the theatre to go see how Sherlock and Alice are getting along.

The afternoon's surgery begins like Sherlock's cases usually do—when he enters the OR, all chatter cuts off to give space for his music. Soon, one of Bach's Brandenburg Concertos is drowning out the sound of the drill and the suction as he begins creating a route through the bony skull for the stereotactic biopsy needle. Its path will be dictated by the fiducials on the scalp which are connected to a camera and a computer model of the imaged tumour in the patient's brain.

Alice is not wearing sterile gear since she is not assisting, but she has changed into scrubs and donned a mask and a disposable surgical hat that covers her blonde hair. She uses very light makeup, and the tennis shoes she had changed into from her heels have obviously been chosen based on practicality only. She watches Sherlock with dedicated but not childishly keen interest and steals occasional glances at the vitals monitor as well. Some surgeons pour their stress into chewing out the anaesthesia team when they think that the blood pressure, the patient's neuromuscular relaxation levels or something else not related directly to the surgical field are making things difficult, but more often than not, the anaesthesia is fine apart from being the chew toy of a surgeon with lacking skills in managing tight spots in their own work.

Alice flinches when Sherlock suddenly calls her name loudly. "Cranial nerve nuclei located in the brainstem, in order of insertion. And _no dithering about it_."

"From the caudal side up: spinal nucleus of accessory nerve, hypoglossal, dorsal nucleus of the vagal nerve, the ambiguus, accessory, vagal proper, glossopharyngeal, superior and inferior salivatory nuclei, geniculum of facial nerve behind the area, facial, abducent, trigeminal, trochlears, oculomotor, red nucleus."

"You forgot the Edinger-Westphal."

"No, I–– I said trochlears in the plural."

"I am not deaf, nor is my hearing comprehension in any way deficit. The Edinger-Westphal, also known as the Accesso-trochlear nucleus, should be specifically differentiated from the nuclei serving a single cranial nerve. Injure that, and you will have ruined several nerves instead of just one."

"Sorry," Alice stammers. Her initial reply had sounded confident, but John can see she's frowning.

"Tell that to your patient when they can no longer constrict their pupil, accommodate their lens or converge their eyes."

Alice replies nothing. John sees the scrub nurse give her an appreciative and sympathetic glance.

"The 2012 WHO classification of ependymal tumours," Sherlock commands next, eyes fixed on the neuronavigator screen.

"Subependymoma, myxopapillary ependymoma, proper ependymomas divided into papillary, clear cell and tanycytic, RELA-fusion positive ependymomas, and anaplastic."

Sherlock stretches his neck by dipping his head towards first his left, then his right shoulder, and readjusts the MRI grid used for the guidance of the biopsy. "Diagnosis of pituitary prolactinomas _prior_ to imaging?"

"Signs include galactorrhea and irregular periods or infertility in women and milk secretion or sexual dysfunction in men, although the former is rare. TSH and thyroxine levels function needs to be checked to rule out a primary thyroid issue, and the patient's medications ruled out as a possible aetiology. The patient's visual fields should be inspected since the optic nerve runs close to the pituitary; anything pressing on it might affect sight. I have presented a case in which an optician sent a patient to A&E because of this and a massive pituitary non-secreting adenoma was found."

"I asked you to tell me about prolactinomas, not to yammer on about pituitary pathology in general," Sherlock tells her brusquely. “Give me the MRI findings in traumatic fat embolism syndrome."

"Foci of vasogenic oedema in a randomly scattered, embolism-typical pattern. A so-called starfield pattern may be visible in the diffusion-weighted slides." Her tone wavers a little but, as her explanation advances, she sounds to John as if she manages to gather a bit of courage and volume.

Sherlock does not reply immediately, and the registrar's face falls. To John, her answers had seemed impressive—astounding, even, for someone still in training.

The air is thick with expectation. Even the scrub nurse's hand has halted, and she's looking at Sherlock expectantly.

He stops just short of grabbing the biopsy needle, withdraws his hand from the instrument tray and sweeps his glance around the room. "What?" he asks, obviously annoyed at this distraction. His eyes then fix on Alice. "Are you expecting some sort of a gold star?" he asks venomously, "As far as I'm concerned, that was the bare minimum expected of you."

The operation continues in silence after that.  
  


-o-0-o-0-o-0-o-0-o-0-o-0-o-  
  


  
"Christ. Now there's two of them to clean up after," John curses under his breath when picking up discarded pieces of clothing from the sitting room, some of them belonging to Sherlock and some to Harry.

"Any luck job-hunting?" he calls out to the kitchen, where his sister is pouring over something on John's laptop.

"I didn't go today."

"Why?" he goes to the kitchen, bundling up the clothes better so that none of them would fall off from under his arm.

"I can go tomorrow."

"Harry––"

Her head snaps up. "I'll sort it, okay? Just––just don't nag, not today. Please." She rubs her closed lids with the heels of her palms.

"Headache?" John asks pointedly. She'd come home in the early hours of the morning; it's now five in the afternoon, and she's in a dressing gown and her pyjama. The remains of her breakfast are still on the table, and John is reminded of when Sherlock had had his halo. In hindsight, he'd been quite depressed by his injury—having to be on sick leave, being stuck in a halo and most of all, anxious about the problems they'd been having—which is why he couldn't be bothered to do much. Harry, on the other hand, has been her usual, moodily cheery self during the past week.

"I'm just–– Look, I'll make a plan, I'll tone down on going out, once I get my head sorted."

"Your head's not getting sorted with vodka shots."

"It helps. For a moment. Nothing else does."

John props the bundle of clothes up on the kitchen island. "There's therapy, and social services, and support groups."

"I'm not going to some AA meeting with a bunch of alkies. That's not what a Watson would do; we don't sit around talking rubbish with some psych. Except for you, apparently, nowadays."

Anger floods over John. He will take a lot from his sister, but he won't be ridiculed for doing something that had been hellishly difficult and horribly embarrassing, but instrumental in salvaging his relationship with Sherlock. "I'm not the one who's homeless and hung over."

"You think that helps? You, making me feel like shit, standing there judging me? I didn't have your brains, okay? Not everyone gets to go to med school and have some fairy tale life being the bloody kept man of some male model brain surgeon! Try living like the rest of us for a while, see how you like it!"

John slams down the lid of the laptop in front of her and shoves it under his armpit. It had been open to the website of some tabloid. "You had every chance I had. Mum left us the same amount of money when she died, and you drank yours. I didn't make you do any of that."

John had worked to be able to afford medical school. He'd used the last of their mother's inheritance to buy a crap car from Harry because she'd needed the money more than she needed transport at that point.

"If you really wanted to help me––" Harry starts.

John knows that tone. "No. I know what you're going to ask, and I'm not giving you a penny more until you start sorting yourself out."

"Listen to yourself! Didn't that therapy teach you any compassion, hmm?

"What therapy taught me was to stop blaming fate or circumstances or other people for my problems." John is proud of how calm he manages to keep his tone.

Harry slides down from the bar stool. "I might go out later, by the way," she announces before retreating to the guest room.

John spreads his arms in defeat, wondering who exactly will be paying for her drinking tonight if he won't.  
  


  
-o-0-o-0-o-0-o-0-o-0-o-

 

Late that night, the front door opens and then bangs shut, signalling the Harry must have made good on his promise. John shuts off the shower just as Sherlock is stepping out of the bath, and now that they have a sudden opportunity for privacy, things heat up as drying off turns into towels being discarded on the bedroom floor instead of being replaced with clothing. John seems to enjoy the blowjob Sherlock treats him to in order to get his cock into a parade rest, and a few strategic hints regarding what he's in the mood for then result in John bending him over the back of an armchair by the window.

Ten minutes later—nobody is really counting them precisely, of course—just as they've shifted to the bed, lying on their sides with John behind him, Sherlock hears the front door again. "For heaven's sake!"

John grips his hips tighter. "Don't mind her. She'll go to bed right away if she's been on a bender."

"She can't have been on a bender unless she started in the guestroom. She can't have been gone for more than half an hour."

John's reply is to trail wet kisses with a bit of teeth down the side of his neck. This helps Sherlock shift his focus back to the feeling of John moving inside him, picking up the pace again.

A sudden banging on the bedroom door makes them both flinch; John's movements stutter to a stop with a frustrated groan.

"Keep it down, will you!" Harry yells through the door.

"This is our bloody flat!" Sherlock yells back.

"You treat all your houseguests to this sort of thing, then?" Harry is laughing.

"We don't get houseguests!" Sherlock protests.

"Wonder why!" That being said, Harry makes her way back down the short set of steps between the bedroom and the corridor.

Sherlock scoffs and glares at the door.

"You _were_ pretty loud, love," John whispers into his ear.

Sherlock is now hell-bent on continuing what they were doing, precisely as loudly as he wants. He reaches his hand behind both of them to slap John's buttock. "Move, then."

"Um, I've already, you know."

Sherlock twists his torso to direct his dismay at his partner. "You did? When?"

"Around the time she knocked. Sorry."

That groan of John's hadn't been out of frustration, then, quite the opposite.

Sherlock is now furious. He should have known it from John's movements and vocalisations—his imminent orgasm is never hard to spot—but he must have been too startled and distracted by the intrusion to notice. And, now both John's erection and Sherlock's taste for chasing his own climax are both a thing of the past. His concentration's gone, and he can practically _feel_ Harry's presence through the door as she is moving around the kitchen, rummaging in the fridge and opening drawers. "She made me miss _that_! Plus, she's used half my mouthwash and taken out all the coins from the parking jar."

"You take out all the coins for the parking jar all the time for your coffee breaks," John points out calmly, pressing a kiss to the curls in the back of his head. "Calm down."

Sherlock isn't calm at all. He's not come, John's hard-on is waning, and he's already pulled out. His hand, which is now reaching around Sherlock's waist to curl around his cock, is suddenly an irritant, not a vehicle of ecstasy. It's a pale consolation price instead of the main event: bringing himself to orgasm while being gloriously fucked by John.

Sherlock slides off the bed and onto his feet, plants them on the floor and rises to his feet, grabbing his blue silk dressing gown from the back of a chair.

"Where are you going?" John asks, pulling a duvet up to cover himself. Sherlock hopes he's got a flannel in hand; otherwise, the sheets have to be changed again, and John tends to make him do it under the pretence that he always tries to sidestep all chores.

"For this, your sister owes me at least a cigarette."

" _Sherlock_. You were doing so well with quitting."

"And I can do well again, once we get rid of her."

"Let's make a date of it the next time she goes out, yeah?"

Sherlock dislikes the languid tone of John's voice, created by a brain still swimming in pleasure hormones. Sherlock's own hormones are currently attacking whatever centre in his brain brings on a very particular mix of restless irritation and bitterness.

"Unless she finds someone else to finance her drinking, she can't go out until you give her money, and she must know it's the last thing you want to do. Can't you see how she's manipulating you?" He ties the sash of his gown.

"Harry isn't that calculating."

"I don't know what's worse: manipulating one's own brother, or not having enough brains to do even that."

"Oi! You and Mycroft are hardly the poster boys of sibling relationships."

Sherlock can tell from the warning tone that John's annoyed with him, now, when the one he should really be angry at is Harry, who is taking liberties no houseguest should take.

He goes to the kitchen where said guest is eating toast, grabs her Mayfair packet from the breakfast bar without a word, ignores her protestations and retreats to the balcony to puff away at least some of his frustrations.

   
  



	4. Bad News

**Notes for the Chapter:**

> Content warnings for this chapter: an emotional encounter with the family of a child who has just been diagnosed with a brain tumour. Discussion of the role of gender in family planning politics, including comments made by Sherlock in his usual highly diplomatic, politically correct and sensitive manner. Terrible, canon-referencing sex puns by John.

 

"I find her distracting," Sherlock grumbles three days later without even being prompted.

"Who? Harry?" Today, it has been established that she really has gone all the way across town to run some errand, so now they are attempting to make up for their last, interrupted lovemaking.

"No, Alice."

"How very––," Straddling Sherlock, John leans down to lick a stripe across Sherlock's nipple, eliciting a shudder, "––charitably honest of you." He straightens his back so that he can crawl back towards the foot of the bed, before trailing his hands down's Sherlock side and then over his hipbones.

Sherlock leans away from him, glaring in disapproval. "You're not listening."

"We came home, you texted Harry to ask where she was, and after she replied you just told me: _'Sex, John. Now!'_ I'm simply going on that piece of information." He nudges his nose closer to Sherlock's groin only to get his face shoved off with a palm.

"I said sex, not--- _that_ bit of it. Not tonight, at least. You only do it when you hope I'll reciprocate. Not that I mind, but your predictability is getting tedious."

"You're so good at it," John defends himself, then accepts that his plan needs to be altered. He lies down next to Sherlock, facing him and dragging his pillow closer so that their noses are nearly touching.

Judging by the stuck-up nose and gaze that has locked itself onto the wallpaper behind John instead of him, Sherlock's brain has run off on its own again, stranding both their cocks alone and unloved.

"You're like the bloody East Wind; you blow or don't blow at very random intervals," John teases. It's chilly in the bedroom, so he grabs a duvet and spreads it over both of them.

Sherlock sticks his toes out from underneath the duvet. "As you should already know from school, the wind system around the British Isles is not random at all. We are currently well south of the polar front––"

John groans. Sometimes he suspects Sherlock might be taking the piss with his snooty lectures, but most of the time he just takes things very, very literally and can't resist a scientific tangent.

John still thinks his analogy had been apt. As Sherlock has said himself, his seemingly random and volatile moods significantly affect his libido, and so do very arbitrary environmental factors since he's sensitive to that sort of thing. During a façade renovation in the building the noise of which had driven Sherlock mad, John had had a severe case of blue balls for six weeks.

Sherlock turns to his back, eyes fixed on the ceiling and nose scrunched up in contemplation. There is no turning his earlier imperative into orgasms before he gets to vent whatever it is that's troubling him, and John knows every attempt of Sherlock's to vocalise his emotions should be encouraged since it is one of the most difficult things in the world for him to do.

"You were saying something about Alice?" John prompts and perches a hand on Sherlock's stomach on top of the duvet, grabbing a hand of fidgeting fingers and slotting his own between them.

"Right, yes. She _hovers_."

"She's your trainee. She's supposed to shadow you when she's not sorting out ward duties or her own operations."

"She could do it remotely. Why does she need to be in the OR with me?"

"I'm not even going to reply to that." Six months earlier, without anyone's permission, Sherlock had tried to implement a system based on Skype- and pre-recorded video responses to handle his outpatient appointments. Tits up is the way that plan had gone.

"You should talk to her, tell her what you expect of her, find a solution together."

"Next you're going to lecture me again how she's my responsibility."

"I don't have to since you are perfectly aware of that."

"You and Lestrade repeating it to me as though I was a demented idiot isn't making it any clearer what to do with her. I just can't––" he trails out, purses his lips.

King's College has been a major teaching hospital for all the time they have worked there. Sherlock is surrounded by neurosurgical trainees and junior doctors all the time and while he is not their favourite, he has done his duty of answering their questions and reviewing their work when he's on ward duty, overseeing their surgeries when requested to do so, and attending to their requests for help when he's on call. There's something very particularly problematic about the fact that Alice is specifically assigned to him that John just can't quite put his finger on. "Sherlock, this isn't some gender thing, is it?"

Sherlock looks absolutely scandalised. "Only an imbecile would think that a woman's ability to become an excellent surgeon is in any way inferior to a man's." He gives John his best what-do-you-take-me-for glare.

"Well, good, then. I was actually surprised you picked her instead of some bloke."

"Now _you're_ being gender-biased. Clearly, she was the best qualified of the applicants. Now that you've mentioned gender––there is one thing that makes female surgeons problematic—their tendency to allocate time for maternity."

"Surgeons should be able to have families like everybody else, and guys are taking leave for that, too, nowadays. Humanity does need a bit of replenishing every once in a while," John reminds him, running the tip of his thumb across Sherlock's knuckles.

Sherlock goes quiet for a moment, then offers a tentative, "This planet is overpopulated as is, but you may be right in one aspect: if only uneducated idiots breed, we're hardly going to have a pool of potential candidates to train as surgeons in the future."

John lets out a long-suffering sigh. "Please remind me to tape your mouth shut whenever we get politicians or journalists visiting the unit."

"I _have_ found that maternity makes many female surgeons exceptionally good at multitasking and time management," Sherlock adds. "Take Laura. I prefer her over any of her male colleagues, especially since many them seem much less motivated by medicine than they are by material things."

"Just–– um–– it's a bit not good, Sherlock, comparing people's abilities based on their gender."

"I _know_ that! That's why I said that only an imbecile would think women inferior as surgeons; they can hardly help the fact that they are the gender stuck with uteri, can they?"

John rolls his eyes with a chuckle.

"Any man who has spent a significant amount of time at home seeing to children could boast the same enhanced abilities," Sherlock muses. "But, it's never the father who does that, is it? Not surgeons, at least."

"I guess you've got a point. Systemic problem, not a gender trait."

"What if..." Sherlock starts tentatively, "What if there are two fathers in a medical family? Who stays home in that situation?"

"I don't know. We don't know any gay couples with families, do we? There's that nurse at the plastics ward, but I don't think his husband is a doctor. Come here," John prompts, spreading his arms.

Sherlock crawls on top of him, and John spreads the duvet over them. He probably knows this is an attempt by John to get his beehive of a brain to wind down by providing a distraction that isn't too intrusive. He wiggles a little to find a good position, slotting his legs between John's, who wraps his arms around him, one hand snaking up so that fingertips can be dug into his scalp. He sighs contentedly.

"I'm not convinced of Lowe's purported abilities," he mutters into John's chest. "Her hands shake in theatre, and she doesn’t know how to compensate for that. There is a big discrepancy between the praise she has garnered in her previous placements and how she is doing now. Whoever taught her how to use Tachosil was an imbecile, and the way she holds the suction should be grounds for capital punishment. I cannot fathom why the other neurosurgeons have not noticed she has these issues."

"We're not allowed to murder registrars," John jokes. _Thank fuck for that. Sherlock would probably see a prime opportunity for practical cadaver research._ Jesus Christ, the level of black humour this relationship has instilled in him.

"We're only allowed to train them. Try it sometime. You sure she doesn't have that issue just when you're in the OR?"

"In that case, she is too easily intimidated."

John refrains from pointing out that Sherlock, in his surgical despot mode, would probably make even a Bengal tiger cower in fear. 

"As I said, you need to discuss these things with her, not me. And now," John says mischievously, "this East Wind will be _coming_ , whether it's in the middle of a polar front or not."

Bad sex humour, Mycroft being sentimental, Dr Who and compliments are the four things in the universe that will crash Sherlock's hard drive and bring on a screen saver -like frantic, confused blinking which John considers rather adorable.

"I'm still hard," Sherlock blurts out.

John is perfectly aware of the cock nudging for attention. "My point exactly," he says and cranes his neck so that he can bury his nose in Sherlock's curls. "Shall I give you a hand with that?"

Sherlock hums encouragingly and grabs a handful of John's arse so that he can grind their groins together.  


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"Right," says Marie, Sherlock's regular outpatient clinic nurse. "It's good this one's the last on the list. Inpatient, so I need to call the ward to escort them here; I couldn't get through to the transport guys before. It's always a mess in the afternoon with understaffing."

Sherlock looks up from clicking through the electronic records of the patient Marie is referring to. The room will likely soon be crowded since both parents often accompany a child patient to these visits.

"You mean these things exhaust you, too?" Sherlock asks.

Maria rearranges the chairs in the room to accommodate more people before grabbing the phone on the table. "Sure, they do. Maybe for different reasons, but they do. Tea after this?"

It's still startling to Sherlock that Marie would voluntarily summon him for a brew after their clinic days. He finds it awkward, being in the break room with all the other staff who dislike him. However, Marie seems to be aware of this, and they often take their tea to a roof terrace where she can have a smoke. Sherlock might ask for a puff if it's been a particularly taxing day. He has told her that John thinks he's quit and mostly, that holds true. That's why he'll only have the one nerve-soothing inhalation. He shouldn't indulge at all today; it's hard enough trying to stay off the cigs when Harry smokes like a chimney even if she does it on the balcony.

The patient they are expecting as the last of the day is Beth Winnicott—thirteen months old with a brain tumour. She'd already been booked for an appointment at the paediatrics outpatient clinic due to periodical vomiting, but yesterday she'd had  a seizure. The urgent MRI done under sedation had revealed a mass above her corpus callosum, pressing on both temporal lobes. Most likely it's a desmoplastic infantile astrocytoma, but before a slice of it has been delivered under a pathologist's microscope, no definite histological diagnosis—and no exact prognosis—can be given. Since the symmetrical shape and location might also mean it's a lymphoma, the treatments of which are not surgery, a biopsy should be done first during the operation instead of going straight for tumour removal. If the frozen sample sent to the pathologist from the operating room yields some other diagnosis, Sherlock will remove the rest of the mass.

He hates these appointments—ones with a not yet precisely diagnosed child. Most of the appointment time will be used up by trying to pierce through the parents' denial and trying to weather their emotional outbursts about hypotheticals. The behaviour seems to be completely understandable for Marie, but even with her there as backup, trying to address those reactions leaves Sherlock feeling helpless and apprehensive—like a bull in a china shop. Marie seems to handle them perfectly well, so he mostly refers to her when wobbling lips turn into full-on crying and barely contained anger and frustration into aggression. He knows the patients and their family members are not really angry at him; he's simply the closest to any deity available to which their distress could be aimed. That's not the part that bothers him even though being a punching bag isn't pleasant; it's being so acutely aware of his own inability to console others and help them deal with the uncertainty that makes these appointments dire affairs. Once the pathological diagnosis comes through, it's easier; some time has passed to allow them to come to terms with the initial news. They may think he's cold since he doesn't get reactively tangled up in the families' pain, but they generally accept it at that point because he's the one who can fix their child, or at least buy them some precious time with them.

Sherlock can't imagine what it would be like to lose a child, in part because he has trouble imagining even having a child of one’s own in the first place. How could someone find the faith to have another one after losing their ability to fool themselves that nothing could happen to an innocent infant? He knows laypeople operate under a blissful ignorance, but as a doctor and as who he has always been, Sherlock has never been able to harbour such illusions. Back in the day, before modern medicine improved survival rates, more than half of a flock of kids in a family often died from malnutrition and infectious diseases. In some respects, that must have inured parents, to at least make them more fatalistic. Now, too many parents fail to appreciate that medicine cannot solve every ill. It's not karma; there is no justice. That's just the way things are: some humans are born with defective cell lines that can mutate and grow into what is pressing against the healthy brain tissue of Beth Winnicott.

Sherlock's stance that the universe is mostly purposeless and uncaring doesn't console the parents. They want _reasons_ , they want meaning, they want to know what they've done wrong or who to blame.

He has no answers for them. Cultivating hope is Marie's game, medical facts are his.

He does hope he was better at making people stop crying. This appointment is a case in point: the mother begins sobbing when Marie lays the little girl down on the appointment room trolley—she does look very out of place on the adult-sized piece of medical furniture.

The father shifts restlessly in his chair as he watches Sherlock go through a neurological status exam adapted for the child's age. Most of this will offer Sherlock little usable information in terms of planning her surgery. Much of this is theatrics, providing consolation through a predictable ritual.

Beth gnaws on her fist until the cold stethoscope touches her chest, and she begins wailing. Marie attracts her attention with a toy so that she calms down and Sherlock can continue.

"It's important that you look like you care about the kid," Marie had once told him when he had argued that there was little need for him to try to engage with the children so that they wouldn't cry—they always seem to do that eventually, anyway. Babies and infants are quite logical and straightforward in some of their reactions, but it eludes him how to address the full-body sorrow they seem to express even at the smallest provocation.

Sherlock knows he's at least rather good with school-age children who can already understand many things and who appreciate his candidness and selective ignoring of their parents. He had hated being talked down to by adults as a child, and he doesn't want his young patients to feel like that.

"We can't have another," the mother suddenly pleads while Sherlock is trying to peer into the squirming infant's retinas with an ophthalmoscope. "She was our last ovum. The only one that took."

"I'm so sorry," Marie says. "But hey, let's just focus on the now."

"Yes. Sorry," Sherlock adds for good measure, and the father nods appreciatively with a sombre expression.

He slides his hands under Beth, who is looking at him with a thoughtful expression, tiny forehead scrunched up.

 _What would it feel like to want to have a child?_ He wonders. _What would John feel right now, watching this one?_

Sherlock doesn't want children, never has. The sight of Beth being curious about him fills him with nothing but trepidation mixed with disinterest.

There is little more he can learn about her illness by examining her. He passes the girl back to the mother, who presses her face into her soft hair that curves into waves where it cascades down her neck and whispers something nonsensical. Anywhere else than in an appointment room of a neurosurgical outpatient clinic, the sight would be downright banal in its carefree normality. Context changes everything.

Unlike many adult patients, parents rarely ask Sherlock the one question they must be thinking about: _will my child die_? He knows that this is because they are terrified of the answer,

"Removal should be possible since the tumour is clearly demarcated," Sherlock says while bringing up the scans and turning the computer screen so that the parents can see.

"The tumour has visible borders," Marie translates as she points to the edges of the white blob in the MRI slides. "That's a good thing. It means that Mister Holmes can see where it starts and ends. He can then remove only the tumour, harming as little healthy brain as possible."

"Will she have fits afterwards?" the mother says, squeezing a tissue in her hand, voice congested.

"Epilepsy is a possibility, though the mass effect of the growth could have been responsible for the seizure she had. Once that is eliminated, it could be that the seizure she had yesterday will remain a singular event."

"When the tumour is no longer pressing on her brain, it might be that she won't have any more fits," Marie pipes in.

At first, Sherlock had been annoyed by her initiative in rephrasing what he says into layman terms, but on more than one occasion, the repetition has appeared to be useful in ensuring patients remember at least the most pertinent bits of information from the appointment.

"How long will the operation take?"

"That largely depends on how long the pathologist takes to look at the frozen sample. If it is a lymphoma, then treatment takes place without further surgery. If I remove the tumour, depending on how slow anaesthesia is being with their initial part, I'd say the whole operation will take between five and seven hours. We may transfer her to the paediatric ITU directly from the operating room, keep her sedated for some time to allow swelling to go down."

"What swelling?" the mother asks, eyes filling with tears again. “They said they put her on cortisone and that would stop the swelling. Is there going to be more, after?"

Sherlock turns the monitor back since neither of the parents is looking at it. "Whenever brain parenchyma is manipulated, it may swell reactively and as a result of local tissue trauma. The swelling now is caused by a local reaction to the tumour, and some of that will continue for a time post-surgically."

"Operating on the brain is a bit like when any wound is created—it'll get a bit swollen and sore. We might let her sleep a while longer after the operation to let her brain heal for a while," Marie promises soothingly.

"But it's curable? You can remove the tumour, and that's it?" the father asks.

Sherlock wants to sigh but refrains. He leans back in his chair. "We cannot discuss prognosis until after the surgery. An operating room has been booked for Friday."

"Can't you do it today?" the father asks. "It's growing all the time, isn't it, and she's so _small_!"

"Less than 48 hours is not a significant delay in this case."

"I know this is difficult for you," Marie says. "Have you got any other questions that Mister Holmes could answer for you today?"

"Is it–– is it–– Did we––" the mother dissolved into sobbing again.

The father gives her a helpless look, his own eyes glistening now. "We were just thinking–– why did this happen? We live close to a power line and my brother, who's an engineer, says that there have been some studies done. What about mobile phones or the LAN router? There's a lot of stuff on the internet––"

"There are sources on the internet who think we never went to the Moon, that the mayor of London is something they call a reptilian alien, and that lung cancer and tobacco have no real connection. Do not go online," Sherlock says. This isn't the first time he's had to address shocked patients and their loved ones scrambling for answers and meaning. "No, this wasn't caused by the LAN router, power lines, Sellafield, vaccines, homogenised milk, Chernobyl fallout, mobile phones or too much television. There is no one to blame, least of all yourselves." All of these things seem to come up in the online discussion forums regularly Sherlock has reviewed to find out what parents' worries are regarding the aetiology of childhood malignancies.

"But kids don't get brain cancer, do they? Not really!" the father announces.

"Approximately six hundred children in the UK alone do, each year," Sherlock replies.

"Which means that there are support groups where your Mummy and Daddy can go to," Marie coos to their patient who is waving her arms about in the mother's lap.

"But there has to be some reason, or some risk factor––" the father trails out.

"We all have faulty cell lines, and when they divide those faults might get fixed, but not always. Sometimes, their mutations make them more viable than other cells, and detrimental to their host. There is no higher power, no magic or meaning there, it's just biology," Sherlock says, trying not to let the frustration of having had so many of these conversations bleed into his voice.

"What Mister Holmes is saying that you really shouldn't blame yourselves. We all have some cells in our bodies which could develop into cancer, but mostly, they don't."

Sherlock feels obliged to be more precise. “We don’t know exactly what _sort_ of cancer she has. Only the pathologist's review of a biopsy can give us more information."

Beth lets out an excited yelp when Marie leans her ear closer and wiggles her head—she has long, red, dangling earrings.

"She's just a child," the father repeats. "She isn't supposed to need a brain operation."

"But, since she does, it's good that she's got an excellent surgeon. Yes. You. Do!" Marie singsongs to the little girl then touches her nose gently with the tip of her forefinger, which elicits a giggle.

"You will be doing the operation?" the father demands. "I don't want some trainee. Lots of people say you are the best, Mister Holmes."

"I promise you, Mister Winnicott, that I wouldn't dream of letting a trainee near her brain."  
  


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"Thank God the Board of Education inspection is as soon as tomorrow," Greg curses over coffee a week later. "Otherwise I think we'd be in trouble if Holmes keeps up with his campaign of terror."

John has been away for two days to attend the most boring admin conference known to man, _'The New Quality Assessment and Lean Management Paradigm in Perioperative Medicine_ ' – _TNQAALMPIPM_ among friends. Meanwhile, administrative duties have piled up, so he hasn't been able to pop down to the OR floor today. "What are you talking about?"

"Well, he's banned Alice from his OR, for starters!"

"What?" John had chalked up Sherlock's griping about the registrar as introductory period growing pains. He had no idea things had got this bad.

"Nobody else complains about her at all. In fact, I talked to the Ward sister and some of the senior surgeons she's done call with are saying that while she can be a bit on the quiet side, she knows her shit and does what she needs to, runs the floor at A&E very efficiently and treats the staff well. However, Sherlock threw her out of the OR and hasn't let her back since."

"What happened exactly?"

"Poor girl's getting so damned nervous when she's assisting him. Hands shaking, even, and you can probably imagine he isn't very impressed. According to the scrub nurse on duty that day, he told her a Cro-Magnon would have done a less of a butcher job with the suction, that he was tired of listening to her, quote: _'pipsqueaking_ ', and that it was the last time he'd put up with her lack of dexterity."

"Jesus." Any trainee would be devastated after such an outburst. A surgeon's temper flaring in the OR is not uncommon but being at the receiving end can be devastating to someone who is still constructing their professional confidence. John still remembers with a shudder an operation he had gassed for as an inexperienced first-year anaesthesia trainee: a senior gastric surgeon known for his foul mouth had told him he'd never amount to anything and that he wouldn't even let his worst enemy be put under by such an incompetent idiot. He'd nearly quit his training post and had been terribly nervous to work with the man again. John doesn't often let other people get to him like that, but he was only a trainee at that stage, and the career he wanted was in the hands of his seniors. Who was he to tell them they were wrong about him?

Every doctor needs a hefty dose of confidence, a thick skin and the ability to separate issues and people. But, if all of a trainee's focus is on the fear that they might mess up in some hard-to-predict manner at any minute, how can they concentrate on learning? A mentor can help build that confidence up in benign, constructive ways; it doesn't have to happen through bullying, and no trainee should be expected to put up with bad behaviour.

"Have you talked to Alice about what happened?" John asks Lestrade. The older neurosurgeon is overtaxed with both clinical and admin duties, but he always has time for his subordinate surgeons. Greg’s paternal and constructive attitude has helped him steer his staff through thick and thin. John highly respects the man; he's an excellent superior.

"I did, yeah, called her in that afternoon when I heard about the incident. She wasn't really in the mood to talk but showed an admirably brave face. She told me that it's fine, that she just needs to do better. I told her that it's not about that, that she's still a trainee and if there are core skills she needs further training in, then it's Sherlock's job to address that instead of chasing her out."

"He hasn't had any registrars before," John reminds him. Everyone has probably assumed that, since he has dealt with trainees before, he should already know his duties as a supervisor. But, he always needs social interaction stuff spelt out to him, so maybe Greg hasn't given him enough of a roadmap about having his own reg. Sherlock has only been a consultant for a few years and considering his major difficulties with social interaction, he had been given a respite from being assigned junior doctors. John had always known this couldn't last forever; the Trust wouldn't have it. The private sector could be an option for doctors unfit for teaching duty, but King's is where Sherlock has built his career, and the Trust is invested in keeping a surgeon of his stature in its staff. This problem needs to be solved, and John has the feeling that Doctor Holmes needs a bit of help with that.

"I know, but I can't be there all the time to hold his bloody hand and tell him to behave, can I?" Lestrade huffs in frustration. "Nor can you. Maybe I should just reassign her to someone else once the inspection's done."

John doesn't like the idea; it would send a rather depressing message to Sherlock even if it does sometimes seem like he is deliberately sabotaging his own chances of managing Alice. "I just wish I could work out what bothers him so much about her. It sounds like there might be a vicious circle going on. He doesn't know how to handle her, so he acts the way he always does when he's apprehensive: bosses everyone around and tries to make them run for the hills so he wouldn't have to deal with them."

Greg crosses his arms. "If everyone else says she's doing fine when she's working with them, the issue must be with him."

"I'm on call tomorrow, and she's on, too," John says. "Let's see how she actually does before I talk to Sherlock—assuming you want me to?"

"I know you hate it when people assume you'll sort these things out, but you know him best, and he listens to you. And yeah, good idea to first see what's going on with her; the staff might just be feeling sorry for her, so they say all these nice things. Wouldn't be the first time we get a rubbish trainee who looked excellent on paper. Remember Dimmock last year?"

John rolls his eyes and sips his coffee. "How could I possibly forget?"  


 


	5. Toxic Cultures

**Summary for the Chapter:**

> Tw: discussions of workplace and school bullying.

 

It's not even the weekend, but John's night on call still brings plenty of work for A&E and the surgical floor: drunks with head injuries, a farmer with a profusely bleeding Achilles tendon injury and a young bipolar woman who had punched her fist through a glass patio door because she had been upset over a breakup. She is taken to the OR since her injuries are so complex that they can't be sorted out with just local injections of lidocaine and some suturing at the A&E department's procedure room.

John gives the still weeping, restless woman an intravenous shot of midazolam and then sets to work locating the brachial nerve plexus in her shoulder. She hasn't been nil-by-mouth for the requisite six hours, but this injury can't wait so John hopes that the nerve block will circumvent a need for general anaesthesia. It should also ensure good pain control for hours after the surgery. Once he has the plexus neatly positioned in the middle of the ultrasound screen, with a neighbouring artery well visualised to avoid hitting it, John advances a long, thin, bevelled needle into the area above the woman's clavicle and injects twenty-five millilitres of relatively long-acting local anaesthetic to block nerve conduction into the whole upper limb. In a few minutes, the patient tells him she feels pins and needles and warmth in her fingers, sure signs of the block kicking in. Back in the day, the technique was based on piercing the artery or using a nerve stimulator to find the pertinent nerve bundles; with those, anatomic variation was much harder to take into account. Ultrasound has been a veritable revolution: now, anaesthetists can _see_ the nerves.

While the patient is washed and draped, John drinks a quick coffee in the break room before returning to theatre.

"Evening, Doctor Watson," Alice greets him as she pushes through the OR doors in his wake, holding her washed and hand sanitiser -doused hands above her waist.

"You can call me John," he says.

She flashes a smile. "Right, good, thank you."

She then turns to the supervising nurse. "The patient is Jenny Hayes, 31 years, with bipolar disorder and allergic asthma." She then flawlessly recites her medications and the long list of broken bones and suspected nerve and blood vessel injuries already discovered, adding in her own suspicions of an avulsion fracture in the distal phalanx of the left middle finger she thinks the radiologist may not have noticed. Instead of sounding triumphantly snooty about it like Sherlock would after spotting something a colleague has missed, she's almost apologetic and comments that the radiologist _had_ , after all, managed to spot an elusive scaphoid fracture line.

Earlier that evening, Alice had called John to say that she suspected a pheochromocytoma as the reason for an ITU stroke patient's unstable and high blood pressures, so she had ordered meta- and normetanephrin tests to be done from the patient's bloodwork. The patient was due for theatre in the morning for the debridement of her craniotomy wound, the edges of which had infected. John had whistled; endocrinological issues were usually instantly turfed to internists. Alice had simply commented that she had always enjoyed such diagnostics and that she'd skipped requesting an internist consult to save time.

To John, there seems to be a huge contrast between Alice's conduct tonight, and the description Lestrade had given after observing her in theatre with Sherlock. John has noticed it before how she rarely speaks much when around him and seems to practically panic when he pays attention to her. Now, out of his orbit, she is not chatty but not so pathologically timid, either. She is fast but not shoddy when assessing patients, and clearly, she knows all the requisite theory related to her field and many other areas of medicine, too.

She sets to work on the hand injury and within the next two hours, John receives further evidence of why her application had arrived with a thick stack of recommendation letters: as a surgeon, she is also fast yet meticulous, and she has a grasp of hand surgical techniques usually only seen in much more experienced surgeons in that particular field. She even requests her pair of enlarging glasses to sew together blood vessels John doubts the average on-call surgeon would ever bother with. She closes the sutures with beautiful, intracutaneously concealed stitches, and instead of escaping the OR as soon as she can, she sticks around to instruct and help the nurses with wrapping and plastering the hand, and to reassure the patient about the potential outcome.

John can leave the patient with the nurses once the plaster is done since there's nothing more for him to do—no waking up process to handle. He has already typed up instructions for the hand surgical ward about pain and nausea medications and intravenous fluids, and the nerve block will ensure that the patient will require little attention in the post-anaesthesia recovery area.

"You've rotated in hand surgery, then?" John asks Alice as they walk out of the OR.

"A relatively short rotation, yes. I did a long stint at gastro during foundation, then a bit of trauma and extended ORL to learn as much as I could about the types of craniofacial surgery they do, before moving on to neuro."

It is now obvious to John that her technical skills are way above those of the average year five trainee. If a short rotation in hand surgery was enough to bring her up to this level of managing hand trauma, it raises the question of what on Earth is going on with Sherlock—why hasn't he realised he's got a very skilled registrar in his service?  


  
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The night turns out to be mostly quiet, and John manages to catch six hours of shuteye while an anaesthesia registrar mans the OR floor. When Sherlock is on call and there is a neurosurgical operation, he is usually the one who needs to do it since very few of his registrars can manage on their own unless the task is very simple like initiating ICP measurement. In contrast, John can usually leave the theatre patients in the hands of the anaesthesia regs at least after the induction phase if things are stable.

In the morning, he would like nothing better than to drop his tie into a bin, pull on a set of scrubs and walk back into the OR for a lovely, simple bread-and-butter cholecystectomy or craniotomy instead of fighting the tide of bureaucratic nonsense imposed upon him by the NHS. These days, being on call tends to awaken a thirst for more patient work and today, returning to the minutiae of admin feels like even more of a drag than usual.

To add insult to injury, the remote conference system crashes during his first meeting of the morning—just as he was about to finally coax a promise for additional call rota funds from the Head of the Board of Trustees.

Just as he punches the reboot button on his computer for the third time, Sherlock walks into his office. Without a word, he drops an envelope addressed to the both of them on John's desk.

"What's this, then?"

"Came in the post yesterday. It's from Baxter. I don't know what it's about, didn't open it."

Dr Allen Baxter, their landlord, rarely contacts them unless he needs to tell them about renovations in the building, or to remind them that their rent is overdue.

John straightens his back from hunching down to reach the computer power button. "Let me get this straight. You bothered to inspect the envelope, but instead of opening it like any sane person would have done, you took even more time to pack it for work and to bring it to me personally. Seriously, Sherlock, what gives?"

"I don't deal with that stuff," his partner tells him. "You know I don't." Confusion has crept into his voice; he truly doesn't seem to grasp John's point. "I didn't just ignore it, this time. I brought it here."

"Right. Because you're physically incapable and intellectually too limited to rip open a fucking envelope and see what's in it. Or, God forbid, pay our bloody rent. I'm sure it's so much more demanding than getting a university degree."

Sherlock pinches the corner of the envelope with disgust and waves it in front of John's nose. "I was merely bringing to your attention that there may be an issue _we_ need to address regarding _our_ rent. You would also have protested if I had seen to it without informing you. It's not my fault if you're in an abysmal mood." He begins to shove the envelope into his pocket, but John snatches it from his grip and slams it on the table.

"I'd be in a better mood if I didn't constantly have to deal with you being a prat. There's been a written complaint from three nurses at the stroke unit over your treatment of Alice."

The head of the unit had phoned John just before the meeting that had been cut off, and the document had been in his email. It had been embarrassing to discuss the incident without having had time to even read it first.

"The stroke unit nurses are a bunch of oversensitive busybodies. I wouldn't have thought you put any stock in their gossip mill."

 _Never mind the bloody stroke unit._ John is annoyed enough that he uses the anger to push through his reluctance to address another training-related issue: "Have you or have you not banned Alice from the OR?"

"I have not. She can sign up to assist in any surgeries she sees fit, as long as it does not interfere with her ward duties."

"And as long as it's not you who's operating?" John suggests.

"If and when she starts shows some aptitude in not potentially botching my cases, I will reconsider."

"Have you considered that she might not be doing so well in the OR because she's so intimidated by you? I watched her work yesterday; she's _fine_. More than fine, in fact."

Sherlock scoffs. "How would you know? You're not a surgeon."

"I have eyes."

They end up in a staring match. John makes note, once again, how discussing Alice instantly slams on both the breaks and the walls in Sherlock's demeanour; he becomes even more evasive than usual when he's being called out on his behaviour, and John just cannot understand why.

He takes a deep breath, not wanting to get into a shouting match. It has never been the way to get through to Sherlock, and the last year had given him an awareness how deeply he can hurt his partner with something he says off-hand, when he's angry. "There seems to be a problem between the two of you that was there even before you even met her." _How do I say this so that it doesn't feel like I'm underlining his…issues?_ "You know you are pretty good at exploiting the fact that you can be quite scary when you're protecting yourself. That's probably why she's so extraordinarily nervous when working with you."

Sherlock crosses his arms after picking a bit of probably imaginary lint off his jacket lapel. "In that case she needs to build some better anxiety control skills. It's hardly my job to teach her how to stiffen up that lip."

"Actually, it just might be. You think the best way to support her with that is to roll her in tar and feathers at every turn?"

"I have done no such thing. You may go for a mollycoddling approach with your anaesthesia trainees, but there's no place for a surgeon who crumbles under pressure."

John bites his tongue. Sherlock definitely does not crumble under pressure, but John has seen even him very rattled and nearly incapable of action when his own brother had ended up on their operating table with a need for emergency surgery. No one is immune to feeling stressed and pressured, regardless of experience level; Sherlock himself gets stressed and reacts adversely to people treating him badly or singling him out at work.

Still, John knows that what he's doing—turning the attention to Sherlock in order to try to solve this—is not going to work, since he won't talk about what's bothering him. When arguing with the man, John has ammunition that might bring him an instant win, but it will also lead to an extended, icy sulk and Sherlock _not_ heeding any advice from him for a long time. As annoyed as John is right now, he needs to keep this constructive.

"Just remember you can't expect the same from trainees as other consultants," John finally says.

Sherlock snorts. "Obviously not. That being said, some consultants—The Botch, for one—are not much better than her. Perhaps, if their training had been more rigorous, we’d be spared from their mediocrity."

John almost points out that Alice is Sherlock's golden chance to remedy that, but he refrains. He needs answers, and he's not going to get them from the man himself.  


  
-o-0-o-0-o-0-o-0-o-0-o-0-o-  
  


Bickering over a case of dural puncture during spinal surgery stretches the neurosurgical unit's M&M meeting until late evening. Sherlock had texted John after six p.m. that he should head home without him. Each consultant acts as chairman at one meeting per year, and it's his turn so he can't leave in the middle of the proceedings.

At least he manages to hail a cab right away after walking into the icy wind outside the Golden Jubilee wing, and the driver is quiet even by London standards.

Arriving home, Sherlock hopes that Harry is out and John is home; he'd love a shared bath or a bit of crap telly on the sofa before bed.

His luck is out: walking into the kitchen, he finds Harry sobbing into John's shoulder and his partner looking patient but pained. He spreads his arms in frustrated capitulation as Harry continues to cry, clearly oblivious to the arrival of a third person. John's anger at him seems to have abated, most likely displaced by Harry's drama.

Sherlock retreats to the bedroom and digs out his laptop. If he won't get to enjoy John's company tonight, he might as well work. He can't help feeling that their relationship and their everyday life has been shoved aside yet again, by someone who is not even a part of it.

It takes John two hours to coax Harry to go to bed, and when he slips into the bedroom he looks so thoroughly wrung out that Sherlock's lingering irritation abates.

"Everything alright?" he asks. It might be the wrong thing to say; after all, a two-hour cry clearly signals extreme distress, but he cannot predict how affected John will be by the spectacle.

"Clara called," John explains, and it's enough of an explanation. "Give Harry a break tonight. Looks like it's truly over between them."

Harry has retreated to the guest bedroom; how is he supposed to give her a break if they won't even interact? Or, does John mean that it is suddenly taboo to speak negatively about her? "How many times is this, again, her wrecking a relationship?"

"I've lost count." John pulls off his T-shirt and slips into bed without brushing his teeth or changing into a pair of pyjama bottoms.

Sherlock has made note that he only forgoes such routines when he's very burdened. "It should be obvious it's the drinking."

"And now she doesn't have any incentive to stop." John sighs, switching off the lamp on the bedside cabinet on his side before setting the alarm.

Sherlock closes the lid of his laptop. He had sorted out his evening routine an hour ago.

"She never did. It's not just this break-up; she needs to find the motivation for herself; mollycoddling her isn't going to work, and other people are just distractions for her."

John gives him a suspicious look down his nose, as if to ask if it takes one to know one.

"She needs to do the work. You can't do it for her," Sherlock adds, mapping John's changing expressions and fearing that continuing the conversation with make him angry again instead of resigned.

"Not everyone's as strong or clever as you; she's hardly going to pick up a book and suddenly want to get sober to go to medical school," John says with a sigh.

"Of course not. But, whatever the incentive that might work is, she sure as hell is not going to find it in our guest bedroom."  
  


-o-0-o-0-o-0-o-0-o-0-o-

  
  
"John?" Nurse Joy Williams has appeared in the break room doorway. "Can I borrow you for a moment?"

He checks his watch pointedly. He's off duty, which Williams must be aware of; he had only dropped by to have a cup of tea before heading to the garage; Sherlock's operation is running late so won't be waiting for John in the car just yet.

Williams glances at the wall clock as if to tell him she knows what the time is. She does not have a habit of bothering doctors over nothing, so John gives her a smile.

"Sure," he relents and follows the nurse down the corridor to a cleaning closet, the door of which is closed. She cocks her head towards it and presses a finger to her lips to signal him to listen.

John raises his eyebrows, studying her expression, until he hears a sound from the closet: a muffled sob, then another, followed by the unmistakeable sound of a nose being blown.

"I think you better handle this one," Williams says and retreats down the corridor.

John knocks, because what else can he do? There's a silence and he can imagine the person on the other side of the door frozen in fright since they've been discovered.

"It's John Watson. Could you open the door, please?"

Eventually, the handle clicks open but the door is only opened a crack.

John slips in and comes face to face with Alice. Her face is red, her eyes puffy and it's obvious what's going on.

She tries to compose herself, with little success. "Doctor Watson, I don't know who called you, but…" she trails out, quickly dabbing a freshly emerged tear on the sleeve of her blue scrub top.

John digs out a napkin he'd shoved into his pocket at lunch. "Here."

She thanks him in a broken voice, then dabs the corner of her eye and looks away.

John almost starts with saying that this is not really his business, but... it _is_ his business. He's the Clinical Director, and all trainee doctors are a part of his responsibility, just as they are the university's Dean's. In his opinion, _every_ trainee doctor is _every_ consultant's responsibility.

"What's the matter?" he asks plainly, adding: "All in confidence, of course."

"I'm trying, I really am, and I don't think I've done anything wrong, I've memorised The List---" Alice starts rambling.

 _The fucking List._ John is going to burn every copy of that list.

"He took over Barsamian's cases for the rest of the week," Alice manages to explain, referring to the fact that Adnan Barsamian, one of their neurosurgical consultants, is off sick with acute cholecystitis. "I'd been assigned to do one of the afternoon shunts with the consultant coming in if needed. He just walked in and took over. I'd already started, and everything was fine! It was like he wouldn't even accept I was there."

 _He ignores me sometimes, too_ , John is tempted to tell her, but it's beside the point.

"I just don't think he likes me much, and I can't tell why," Alice concludes. "I've been here for months—a significant chunk of my remaining training. I can't go on like this. I should ask for a transfer to another Deanery, but that hardly looks good on my records."

They could easily rearrange registrar assignments, but John has a hunch that it would only put some other poor trainee in Alice's shoes for Sherlock to mismanage. As he, Greg and now even Alice have discerned, the issue may not even be specific to her at all.

This needs to be addressed, and it needs to be addressed now. Being tough and demanding on trainees is alright but decimating someone's confidence and not even giving them a chance is _not on_.

Suddenly, a question occurs to John he can't believe no one has asked before. It might not be relevant, but he wants to keep her talking, to let her blow off some frustration. That's what this is, ultimately: frustration over the unfairness of how she is being treated. "Alice––why did you want to come here for your specialty training? You specifically requested to be placed with Sherl––Mister Holmes. Was there a particular reason for that?"

"I know he does combined sinus and cerebral surgery without an accompanying ORL, which is rare. But, most of all it's because I knew he was trained by Jan Andreason at the National. Mister Holmes is the last one he trained, and lots of colleagues say he's clearly the best of his trainees, too."

"You really did your homework before the Match," John extols. Jan Andreason is a pioneer in many neurosurgical techniques and famous for not relying on fancy equipment as much as he relied on his own dexterity. John has seen videos of some of his operations; his skills leave even non-surgeons gaping in awe.

No wonder Sherlock is so bloody good; he has the talent, and he's had a mentor who could cultivate it to its fullest.

"I didn't know all that just because I googled stuff for the Match," Alice admits vaguely. She takes off her scrub hat, pulls of the elastic band keeping her ponytail together and lifts part of her hair, revealing a long scar. "You could say that I'm where I am because of Andreason, too. He operated on a grade II astrocytoma no one else dared to operate on based on its location; I was the patient. I know he died of a heart attack a few years ago, so I never got to study under him. Thanks to Andreason, I'm alive; he made me want to become a neurosurgeon, and Mister Holmes appeared to be the next best thing so the choice was obvious where to apply."

John is speechless, and even more determined than before to help fix everything. Many childhood cancer patients he has met see doctors and nurses as their heroes and heroines and state those as their dream professions, but out of those who survive their illnesses, few become either, and fewer still discover that they just might be downright prodigious at their chosen specialty. Alice's childhood dreams certainly weren't unfounded.

It's tough enough being a young doctor—John knows this from experience. He also knows that it's even harder being a young _female_ doctor, especially in an operative field populated by ambitious and aggressive individuals and lingering misogyny from days long gone. Sherlock had said it: women can be just as good as men as surgeons, if not better; there needs to be room for those like Alice. The system can't waste talent like her by chasing her out because she isn't sociopathic enough to bulldoze her way through a system where her gender might still a handicap and where bullying for other reasons is also allowed.

John knows he has no right to reveal things he knows about Sherlock's past, but he needs to help defuse this before Alice risks becoming another item on a long list of burned out, desperate young doctors. Every single one who falls between the cracks puts the medical community to shame.

"Alice, there are things you don't know, things that affect the way you're being treated. Some people have a very good poker face, and they hide behind bad behaviour a lot of stuff they don't want to deal with. I think that…at one point, you and Holmes had much more in common than you think when it comes to training. Whatever is causing these problems is going to be more about him than it is about you. You won't believe me right now, but I think he's as stressed out by all this as you are."

Alice looks deeply sceptical. "Not everyone is born with the confidence of a tyrannosaurus rex."

John chuckles. Sherlock has been called many things, but this is a new one. "No, they really are not."  _Especially not Sherlock_ , he thinks, but doesn't say it out loud. "Look, the thing to do in these situations is to talk to OH––"

Alice lets out a wet sound that's half a snort and half a sob. " _No!_ Mister Holmes says that only an idiot would go there for anything. He already thinks I'm useless; I don't want to add that to the list."

John is tempted to point out that he and Sherlock have both needed Occupational Health services during their careers, but Sherlock would wring his neck if he mentioned the reason Lestrade had once contacted them on the man's behalf. "It's fine to need a bit of support, Alice—that doesn't reflect badly on you at all."

Her expression tells John that she's still thinking about Sherlock's opinion on the matter. She looks miserable, and John is reminded of what happened four years earlier in the ENT department; an eccentric consultant bullied a trainee who was afraid to speak out. His mental health deteriorated so much that he failed his DO-HNS exam twice, and ended up committing suicide. Shockingly many young doctors have chosen that path in recent years.

Against this backdrop, John appreciates the gravity of the situation. "We should at least talk to the Program Director, get you reassigned to someone else if this isn't working out."

Alice shakes her head. "They're all in this unit—all the SpR and fellow positions for neurosurgery in this Trust, I mean. Even if I got assigned under someone else, I'd still have to work with him at the wards and when I'm on call."

John knows that she could probably transfer to another Deanery, but that would require a lot of effort and she'd probably lose a lot of time. It would also be a shadow on her record—anyone would be more likely to believe the fault was with her for needing to swap, no matter what her recommendation letters might say.

"I have heard nothing but good things about your performance," John assures her; "I'm sure you could get other consultants to speak on your behalf if need be for the transfer process."

Alice's mouth tightens into a line. "Doctor Watson––"

"Call me John."

"John. I knew what I was in for when I applied here. I'd heard the stories about him, but I was encouraged by the seniors at my prior rotations to go for the best; they thought I could do it. He's not the first, um––let's say difficult surgeon I've worked with, not by far. And, I never thought I was some shrinking violet who couldn't deal with someone who wasn't very soft in their training approach. It's just that I have no idea what I'm doing wrong and what he's going to sink his teeth into next! What’s worse is that now, most of the time he just ignores me!"

John frowns. "He does answer your calls and answer questions, doesn't he? When it comes to patient care?" Sherlock wouldn't be so stupid as to leave a trainee without the necessary support because the responsibility would be his if a patient was endangered.

"He answers, yes, but he makes me feel like such as idiot every time." Alice swipes at her eyes which are overflowing with tears again on the napkin John had given him. "I'm sorry, this is…I shouldn't be like this."

"We're not machines, Alice. We have to be able take a lot of shit from a lot of people, and it's twice as hard without the armour of experience. With a consultant it's not the same as with a peer—they outrank you, so you can't give as good as you get. Part of training is to grow a thick skin, but when we stop caring and hurting and feeling when someone hurts us or when something bad happens, that's the day we need to hang up the white coat and take a long hard look at our own humanity. You have a right to feel like this. What's going on is not acceptable, Alice, and it's not your fault. "

"They don't teach you this stuff at medical college, do they?"

"They really, _really_ don't. And, once more for the record, you're doing fine. You seem to have even tamed Nurse Bell at the neurosurgical ward, who definitely has a bit of a tendency to try to boss junior doctors around."

"The other staff are really nice. It's just that with Mister Holmes––" she trails out, looking embarrassed now, probably because she still feels she shouldn't say negative things about her superior.

It's telling that she is still not even on a first name bases with Sherlock, who tends to call her 'trainee' or nothing at all. Not Alice, not Doctor Lowe.

"It's fine," John reassures her. "Whatever you want to say, I'm pretty sure he's been described in even worse terms plenty of times. Can you tell me what makes you so nervous around him?"

"He reminds me of…things. It's stupid, I should be over it."

"If it's affecting your work, it isn't stupid at all."

"I was eleven when they diagnosed the tumour. I had to have three surgeries, chemo and radiation treatment. I spent most of my teen years looking like Buddha, and the boys in the class let me hear it. It didn't help that I got good grades in all the subjects they thought were the boys' domain."

Anger surges in John. Alice has survived cancer, got bullied by some idiots, still scraped her way through, got into medical school, survived the tough first years of specialty training and now she's being bullied again. By _Sherlock_ , who should fucking know better after obviously having been the so-not-popular-boy in school himself. He doesn't talk about his childhood much, but judging by what he has shared with John, he could probably compare notes with Alice about being the victim of a school culture that does not award being different with understanding or sensitivity.

John lays a palm on Alice's shoulder, opens the closet door and nods towards the hallway. "Alice, please believe me when I tell you that what looks like a tyrannosaurus may just be projection; an attempt to hide the fact that the person inside is really nervous too and doesn't know how to act. Look, we'll work something out. It will get better, I promise. What we need right now, though, is some tea and biscuits, yeah?"

It's the English knee-jerk reaction is a crisis, but it _works_. John tries to sound encouraging as he leads the way to the break room, chatting about this and that to get Alice's mind off her worries.

As they have tea in the thankfully empty break room, John starts racking his brain regarding how to make good on the promise he's just made. Trying to talk to Sherlock about this is a dead end, so he needs to find another way.

He needs to do some investigating.  
  


**Notes for the Chapter:**

> [The Match](https://meded.med.uky.edu/news/match-day-results-change-lives-uk-medical-students) explained.


	6. Acid Reflux

 

The letter from their landlord turns out to be nothing more sinister than an invitation for cocktails at a country club for the man's seventieth birthday. Sherlock will likely scoff and refuse; John might go on his own. He prefers to have Sherlock's company for such things, of course, but on occasion, it's nice not to have to focus on him when socialising.

A less reassuring development is that Alice does not show up for work the following morning. Instead, Greg tells John he had received a call from Occupational Health stating that they've written her off for sick leave. Even if it's just for a couple of days, it's still worrying, especially since the OH physician who had called Greg had bluntly stated that if stressors in her work environment are not addressed within the next two weeks, there will be a report to the Deanery.

Greg is as frustrated as John. "I can't just go and order him to be nice; it doesn't work that way."

"Don't I know it," John scoffs.

"I don't want to run this place like a bloody gladiator arena where you have to be able to beat the lion to be able to reach consultancy." Greg says, "I like to think we're grown more civilised than that."

This isn't just talk. Greg has been instrumental in mending fences and resolving some decades-long standing feuds between doctors both in his own department and in other specialities. Sherlock, however, had proven to be a tough nut to crack even for him. Then, John and Sherlock had become acquainted, and King's College's moodiest neurosurgeon had begun to change.

Still, John refuses to take all the credit. He isn't entirely sure what exactly he'd done to make Sherlock make more of an effort to interact with others in a more constructive manner, but Sherlock is the one who has put in the work. There just might be some similarities between then and what is going on with Alice; Sherlock's default way of dealing with challenging social situations is to repel everyone. _Better to be hated than risk embarrassment?_

That's why this thing with Alice is so confounding and disheartening: it's like going back to square one. John had believed he had helped Sherlock see the benefits of building good working relationships with others; things tended to run smoother when one was not being opposed from every front. The way he's behaving, now, is not the Sherlock of recent years. It's something else…almost like a panic reaction to something on which John can't quite put his finger. He has dealt with plenty of trainees before; what is it about being assigned one that has him so freaked out?

"It can't be a trainee's responsibility to resolve this," John points out. "And I'd hate for this to escalate. Good luck trying to get him to change after he's been chewed up by the Deanery." An inquiry would not affect Sherlock's career much, but it would decimate any chance of remedying the situation. John is convinced that all it would do is to ensure Sherlock would steer clear of all trainees from now on. Since the inspection is now done, it's possible to relieve him from such duties, but it would mean that all of his impressive skills and knowledge would die with him.

Greg is looking at John hopefully. "Alice is not the last trainee he'll have to communicate with, no matter how much he and us and probably all the British neurosurgical regs combined would hope." King's College is a teaching hospital that trains lots of surgeons; unless Sherlock abandoned clinical work entirely in lieu of research of a career in the private sector, he can't work without encountering and having to work with junior doctors.

"You know, I'm not exactly sure about that last one," John says. Other people talking down his partner never fails to make him defensive. "Sherlock is actually pretty good at explaining things to colleagues because he does that all the time; it's because he assumes everyone else is an idiot who needs detailed and logical explanations about stuff that comes easily to him. He's dedicated to his work and goes above and beyond when a fellow surgeon asks for his help, even comes to the OR to assist without prompting. If we could just rewire his brain to get what this training juniors thing is about, he could be a bloody good teacher to the right trainees."

"Lowe is obviously worth his time," Greg confirms, twirling a pen in his fingers. "You've seen her operate, haven't you?"

"Yeah. Sherlock has her completely spooked, but when they're not in the same theatre, she can hold her own."

"I did an emergency move of assigning her to continue to work with Anderson for the rest of the week. She already replied to my email and said she's alright with that."

"That's still letting Sherlock off the hook, at least for this week."

"She obviously needs a breather, John, and some proper OR time. Philip is patient, lets his trainees do a lot of stuff, and his own reg is currently on holidays. Do you think I should just reassign her to someone else?"

That option would be the easiest, but it would leave a bitter taste in everyone's mouth, Alice included. John desperately likes to think there could be a better solution. "Right. That buys us some time to sort this out, at least. I think I have an idea how to start working this whole thing out."

"Do share." Greg leans back in his chair, dropping the pen on the desk.

"It's something Alice said; she knows who mentored Sherlock for the most part at the National; looks like he had a pretty intense training relationship with this guy. Maybe something happened there; he's never been keen to talk about his time at the National and I used to think it was just the court case, but what if there's more?"

"I'm sorry if it's you who needs to take the proverbial bull by the horns again."

"It's alright. I can get through to him, I think, once I know what's going on."

Greg nods. "Well, you can try."

John's step as he makes his way back to his own office is a bit more of a march than usual. He does have an idea—one Sherlock will not be happy about afterwards. In essence, John is going to do what every decent physician should do when faced with a problem beyond their own expertise: he needs a consult from a colleague.

Once back in his own office, he googles the number for University College's—of which the National's medical speciality training programs operate under—Program Director for neurosurgery.

_Into battle._   
  


-o-0-o-0-o-0-o-0-o-0-o-0-o-  
  
  


 _Never again._ That's what Sherlock had sworn to himself. Joining John for one of his psychotherapy sessions had brought back plenty enough bad memories about the so-called specialists Sherlock had been dragged to as a child and a teenager. They all wanted to help him sham being normal—whatever that even was supposed to mean—to make him behave, to get him to adhere to the arbitrary and counter-intuitive rules of human social interaction dictated by people who are not like him. The only measure of success, according to the therapists, was how well he managed to hide who he really was. While the approaches favoured by psychotherapist and neuropsychiatrists may have changed immensely during the last decades—becoming much more benign and accepting of neurodiversity—the memories of those more oppressive attempts to 'help' him will always make him suspicious and dismissive of professional counselling.

Never again, he had sworn, yet he finds himself sitting in an uncomfortable chair in the waiting room of a Harley Street psychotherapy practice.

He's not here for himself. He's here for John and for their relationship; to find out whether he has discovered a potential deal-breaker for John when it comes to the longevity of their union. Sherlock had scheduled this appointment for his lunch break, since attending one after work would require him to tell John why wasn't going to carpool home—or come up with a suitable lie. The thought is hateful; dishonesty and concealment of important things have clearly been a threat to their relationship before. A lie of omission is at least slightly less of a bad thing than a proper lie.

He doesn't need therapy; what he needs is an expert consult who has data available from several subjects. Sherlock only has one—himself—and any generalisations made from a singular case are unlikely to be valid. _Observer bias._ He could have tried to rely on research evidence, but there isn't much of it available, and if crisis he and John had fumbled through after Afghanistan taught him one thing: when it comes to emotions, he isn't as good at interpreting evidence and applying science to practice as he would like.

It's simple, really: he needs an outside opinion, and this therapist might be able to provide one, thanks to her specialisation on individuals on the Spectrum. He had meticulously researched her background, not wanting to rely on just John's assessment of her usefulness. Sherlock had liked the things John had quoted her saying, but he doesn't know what things John had _not_ relayed to him from his two appointments with her. This may prove entirely fruitless, but it's worth a try if Sherlock wants to avoid, once again, becoming bitter and depressed by his own inability solve their relationship problems. This time, he wants to know whether he could even be capable of addressing this particular conundrum or not.

He grasps the fingers of his left hand inside those of his right one to still them; he's been tapping them nervously against his knee waiting for his appointment. His palms are sweating.

The door opens, and his heart leaps into a jumpy allegretto, extrasystolic beats mixed with a frantic sinus rhythm, and excessive autonomic sympathetic activation is making him feel like there's a constriction in his throat.

A thin, middle-aged woman wearing a grey woollen dress with a white shirt underneath strides to him and extends a hand. "Mister Holmes, I presume." Her grip is firm.

Sherlock doesn't offer a first-name basis. "Doctor Pichler." After letting go of her hand, he clasps his hands behind his back, quickly running the fingernail of his right thumb along the fingertips. Back and forth, back and forth. It isn't calming him as much as it should.

"Come on in," she prompts and extends an open palm towards the appointment room.

Sherlock sucks in a sharp breath, and walks in, shoving his shaking hands into his jacket pockets. A quick, sweeping glance around the room allows him to deduce where he is to sit, and does so without prompting. He'd prefer to remain standing, but he doubts he'd be able to resist pacing or otherwise trying to defuse his nervous energy in a manner obvious enough to be mortifying.

Doctor Pichler quietly shuts the door, then keeps her distance. "Prospective clients are often very nervous at this point. Please feel free to engage with your need to stim, if at all necessary. I assure you that it is an everyday occurrence in this room, and I believe I have seen it all. Best focus our energy on more important things than keeping up appearances, yes?"

Sherlock lays his palms flats against the fabric of the small sofa. Thankfully, it is not a cheap, raspy wool mix but some sort of a silk weave. It's clearly expensive and surprisingly soothing in its smoothness and the geometrical patterns that feel like braille underneath his fingertips. There are pillows next to him on the seat; one with tassels and one covered with tight, woollen nubs. He can't resist touching them—spun, soft merino sheep wool instead of coarser varieties.

There's an aquarium in a corner. He has always liked the ambient sound of water, and the filter is making a pleasant, low, warbling sound. He doesn't know what the fish swimming around in it are called, but they are flat and colourful, with whisker-like proboscis. Their rainbow-like flank colours are complemented with tiny white dots. Sherlock allows himself to be distracted for a moment by their slow swimming.

"Pearl gouramis. Beautiful, aren't they? A pet shop on De Walden Street provided them, and I am happy for them to come in and take care of them for me. Come have a look," the psychiatrist prompts.

Sherlock obeys, wondering if some calculated technique of breaking the ice is being implemented on him right now. Even if that is the case, he feels no need to object.

They stand by the tank, watching the fish doing whatever it is they are doing as they poke about in the bottom sand.

"I must say I was surprised to find your name in my reservation book," Doctor Pichler says.

"Why is that?"

"I remember John well, and _Sherlock_ is hardly a name one would easily forget. He was adamant you would never wish to seek an appointment with me—or with anyone. I should feel quite honoured," she jokes gently. "Ready to tell me what's on your mind?"

_No. Not ready. But needs must._

"You work with adults on the Spectrum." Sherlock knows he has a habit for asking difficult questions without actually asking them; he makes statements and prays for the other person to latch on and continue. To fill in the blanks. To spare him the embarrassment of saying the wrong thing or admitting something about himself he abhors.

"Yes, I do. I have some adolescent clients, but it is not the core of my practice."

"Some of your adult patients may have children," he suggests.

Doctor Pichler's lips roll slightly inwards against one another. "Yes. Quite many of the couples I see have families."

"In your experience, does it work, or does the _normal_ ––" he spits out the word like a bad taste, "––partner bear the brunt of the child-rearing responsibilities? Do the children perform alright academically? Do they form friendships? Are they bullied? Because they have a neuroatypical parent?"

They return to their respective chairs. Doctor Pichler crosses her ankles and leans back, deep in thought. "May I sweep all that aside for a moment so that I could ask one question from you, first?"

"If you must," Sherlock replies, wincing at the unintended sharpness in his tone.

"Do you want children?"

"No."

"Why, do you think?"

"The reason is two-fold. First of all, I have never felt any manner of a biological impulse to have them, nor do even the positive aspects of having a family entice me in any way. While I have no trouble admitting that those positive aspects must exist for others, I am simply drawn to other things in my life."

"And the second reason?"

"Even if I wanted to, I fear my involvement would be detrimental to the child."

"You sound quite confident and at peace about not wanting children. Is it this second notion that troubles you?"

_She is good at asking the right questions. John was not wrong._

"It is what I believe, but I would wish to hear your professional opinion."

"Can you tell me about the timing of this becoming an important question for you? There is always a reason why clients reach out to me at a certain time in their lives."

"John and I have not discussed child-rearing. I believe such a discussion will need to happen sooner or later, and I want to be able to offer John a solid, impartial view on why my answer is no. He always believes the best of me, and sometimes his optimism is deeply unfounded."

"Would it make it easier for you to say no because someone told you that you would not be good at parenting?"

"If John wants children, then that notion—a professional opinion that I would not be suitable—would make it not––"

Doctor Pichler frowns.

"––not entirely my fault. I did not choose to be the way I am; it is simply down to individual variations in brain chemistry and physiology and anatomy. A genetic short straw, if you may. It is not my fault." He hates the fact that the sentence sounds defensive, no matter how confidently he says it.

"A short straw?"

"While some––attributes to being on the Spectrum have been beneficial to my academic career, and John keeps insisting some of them may actually be beneficial to a relationship, for the most part, they make life difficult."

"You appear to sort your personality traits into two groups: the good and the bad, and the bad are largely associated with being on the Spectrum. As I recall, John never saw things in such a black and white manner. In fact, he never seemed to separate those traits from the whole package, the big picture, the sum total of who you are. Those things are a part of you; he has not chosen only to appreciate the other ones."

This makes Sherlock feel guilty; guilty for not seeing himself the way John does, for not being so lenient and accepting of himself. "Would John not object to you disclosing the contents of your conversations?"

"When he pointed out that he doubts you would ever sit on my sofa, he also said that if that happened, I would have a carte blanche to share our conversations if they could in any way be beneficial."

"I doubt he thought it through. As you said, he never believed I would consult you."

Doctor Pichler shifts in her chair. "It is perfectly acceptable for someone not to want children regardless of whether they would be capable as a parent."

"I know!" he snaps, then regrets the outburst. "I just––I don't want to disappoint him. I will, probably, but I hope to provide him with a reason that is just a fact of life, not an opinion. He makes concessions for me, though he says he doesn't; I want to help him accept my answer, and for that to happen _I_ need to know it is based on fact and not conjecture. Perhaps––" he hesitates, wringing his hands, "––it would be best if the truth turned out to be that I shouldn't even consider it, not even if I wanted children."

Her eyes soften. "Being on the Spectrum does not automatically make someone an incompetent or harmful parent. After all I have seen, after all the patients and their partners I have helped, I believe fully and absolutely that being on the Spectrum is not a determinant of parenting skills. Many autistic individuals highly value certain features in children's thinking: their enthusiasm for the interests, their honesty. Not all people on the Spectrum are the same, of course; there are good and bad parents in both neurotypical and autistic individuals; you don't need me to tell you that. But, I want to re-emphasise that a parent's autism alone is not detrimental to a child, even if it might make family life more challenging than average. Some individuals on the Spectrum can help their children with learning to appreciate routines and to create daily structures that are supportive. Others can often relate very well to children not seeing the need for certain social rules and having to work hard at learning them. Empathy for those who are different is an essential part of teaching children how to deal with others, and due to their own experiences, many parents on the Spectrum have this in spades. I do not know you very well; most of what I know comes from discussing you with your partner, but I have no reason to assume, off the bat, that you would be unsuited to be a parent. That sort of judgment is hard to make and should not be done lightly."

"People make judgments all the time, thinking they are doing someone a favour. But, they don’t; in fact, they can do more harm than good. It's best not to have anyone whose words can make a deep impact, good _or_ bad, because what if that person leaves and then you don't know how to function without them? Then you're all alone and have no skills of your own to deal with the situation."

"I'm not sure I follow. Do you mean that you are worried about the impact of the issue of children on your relationship with John?"

"Yes––no––I'm––that's not about John," Sherlock admits, frustrated.

"Is there something else going on that has brought this issue to the surface?"

"I shouldn't be responsible for anyone. It's fine being with John; we're partners, equals, if you will, but it's dangerous, being responsible for someone's life. Or training someone. There are just some things I am not willing to take on. Things I shouldn't do, because it's risky."

This isn't what he had meant to discuss. Anxiety surges in, and he quickly stands up. "Thank you. I believe you have answered my question."

Doctor Pichler also climbs to her feet, clearly surprised at his sudden decision to end the session. "Mister Holmes…may I call you Sherlock?"

"There's no need, seeing as I now have what I came for." He gives the psychiatrist a curt nod, then walks out.

  
  
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John, too, heads out of the hospital for lunch.

The maitre d's nod borders on a bow as he opens the door to him. His first glimpse of the double Michelin star restaurant Eleni as just as impressive as he had expected: modern chandeliers, water running down fountains built into the wall, black leather, chrome, vases of red roses everywhere. The windows have been covered with thick, blood-red velvet drapes.

He's shown to a table at a quiet corner, a glass of water appearing instantly. He glances at his watch, finding out that he's a bit early, but only a few minutes. That is good, because the restaurant is mostly empty, and the attention of the staff is making him uncomfortable. This seems like a place for someone who enjoys attention, demands it, savours it.

John has always preferred having a bit of privacy for a meal.

He skims through the short lunch menu. The descriptions aren't really all that descriptive—mostly just lists of three ingredients or elements such as _'birch, cod, turnip_ ' for one of the mains. He wonders if the portions will be as small and weird and the menu makes them sound. Sherlock would throw a fit over such a menu: he's a very picky eater who will usually only accept a restaurant he has tried before, or one willing to both put up with his whims and special requests, including offering very detailed descriptions of every dish. At first, John had thought he was just fishing for attention, but after the Lychee Scandal of 2012—' _They have the consistency of pickled testicles_ , _John!_ '—and The Great Oatmeal Sulk of 2013— _'Anything that slimy and clammy should have a head and belong to the taxonomy of snails!_ —John is very willing to bend if it means he gets to eat an entire meal without having to run after a Sherlock who has marched out of the restaurant.

A waiter inquires if he'd like a drink before his company arrives, and despite this being a working lunch, John opts for a whiskey. He doesn't have OR duties today, just admin, and since their car is at the garage for maintenance, they will be taking a taxi home, anyway.

He only manages one sip of his Cragganmore before the front door is opened, and a woman walks in, scans the dining room and heads straight towards him. She is lithe, not very tall, and her blackish brown hair has been blown into a round, soft shape. Her expression and her steps, however, do not speak of softness. She manoeuvres the short walk between tables with her head up high despite her stiletto heels. John catches a glimpse of the shoe bottoms and sees red—he can't recall the name of the brand to which that is a staple but knows they are expensive. Her form-hugging emerald green cocktail dress with a matching jacket with mock military epaulettes on the shoulders completes the look of someone in charge.

That she is—being the Educational Supervisor for The Universe College London Hospitals, including the National. Her job description includes making all the executive decisions regarding the training of specialist doctors in the units under her. If there is something useful to be learned about Sherlock's time within that NHS trust, she is the person to ask, and on the phone, she had instantly recognised his name and told John that she certainly does have some stories to tell. Not that she could divulge much, she had pointed out; _"privacy rules and non-disclosure agreements do exist in these matters, as I'm sure you know, Doctor John Watson"._ However, before John had worked out what he could use to make her more amenable to talking, she was a step ahead: " _However, who would object to an informal chat between colleagues over lunch? I would be very curious to hear what has become of one of our most troublesome and interesting trainees_."

She had not _suggested_ a restaurant—instead, she had simply announced a place and time. John hopes she'll be paying as well since the menu he’d been handed didn't even list prices. _Always a bad sign._

"Doctor Watson?" she extends her hand, a thick gold bracelet dangling from the exquisitely graceful wrist.

John stands up and nods, shakes the offered hand, and they have a seat with the assistance of two waiters.

"Good to meet you, Doctor Adler."

She quickly arranges her thick linen napkin on her crossed legs and drags her chair closer to the table, examining him intently. "Irene, please. Doctor Adler was my father," she instructs with a modicum of distaste.

John has googled her. A pioneering gynaecologist who began her career in radical endometriosis surgery, she had later on specialised in vaginal reconstruction for trauma and cancer patients. She has become a somewhat popular speaker on the conference scene on the subject of female sexuality; John had even found a few ladies' magazine articles where she had opened her wardrobe and her home to reporters. In many of the photos she was with her spouse, Kate Ashwood, who is a solicitor.

Irene suggests the three-course chef's signature lunch menu and John concedes. She picks a bottle of wine without consulting him, after which they exchange a few niceties.

"I can just tell you're a Burgundy man," Irene tells him. John wouldn't consider himself a wine enthusiast, but he does know what he likes, and the Romanée-Conti Irene has just ordered will most likely be delectable.

"So, why the interest in Sherlock Holmes?" Irene then asks, the name rolling off her tongue in a way John doesn't really like. She reminds him of wines he has _not_ enjoyed; ones where a bitterness of cherry stone is just too intense.

"He's one of our consultants, and an issue regarding his interactions with his assigned registrar has arisen which I'd very much like to resolve," John explains. "Holmes is not forthcoming about his past, but I know him well enough to think something may have happened that is affecting what's going on, now."

"You know him _well_ , you say? That's a feat not many can boast. He came across as a very private person, which I think was part of why he was never included in the camaraderie between trainees. As you must know, the first years of training can be difficult and peer support vital. If someone does not partake in that, they will be treated with suspicion and arrogance is often assumed as the reason. He complied with the stereotype and reaped the results."

John nods and takes a sip of water to avoid the whiskey hitting his head too hard since he's having it on an empty stomach. If he's asking for honesty and practically a breach of confidentiality from this woman, he should probably start with a bit of trust himself. "He's my fiancé, which both complicates matters and makes me the most logical choice to address this," he says plainly.

If Irene is surprised by their involvement, she conceals it well, simply nodding and giving him a conspiratorial smile. "He was a fascinating young man, and it is frankly a crying shame that our neurosurgical unit chiefs did not recognise that after Andreason retired. He was Holmes' great defender because Holmes was most definitely his protégé above all others. If Andreason hadn't died, I'm sure their collaboration would have given a nice kick in the arse to our then somewhat stagnant brain tumour research. Andreason was a clinician through and through, but it was apparent Holmes had talents for both academia and the practical side of surgery."

"When did he die?"

"It was right before Sherlock left us for King's. Right before he decided to _grow a pair_."

"What do you mean?" It sounds to John as though the sudden departure of a mentor had lead Sherlock to react badly. "I thought he left because of the court case.”

Their starters arrive, but Irene does not pick up a fork just yet. "The Baxter case was only taken to court after Sherlock had already told us he was applying to transfer out."

John ignores his food, finding himself most disinterested in his _'salmon, clay, mango_ '.

Without any further prompting, Irene begins recounting the early stages of Sherlock's training at the National, and the man she describes doesn't fit the image John has of him from the early days of their acquaintance. She describes a quiet, reserved young surgeon who avoided human interaction like the plague. Some older nurses had practically chewed him up and spat him out for his unwillingness to communicate, and many doctors had hardly been any nicer to him. Most of his peer group just ignored him, but others took a more active dislike. Slowly, a picture emerges of bullying much more severe than to what Alice is currently being subjected.

According to Irene, Sherlock had tried to keep a low profile, to put his nose to the grindstone, but the others made sure that he missed all opportunities they could possibly deprive him of, to find his footing in the unit.

Things changed, when Andreason, a Norwegian-born legendary surgeon already close to retirement age, noticed his dedication and his skills and despite not being the supervisor Sherlock had been assigned to, the man became his mentor. He arranged for Sherlock to be his assisted nearly daily, which created bad blood between Sherlock and some of the consultants who felt like he was allowed to neglect his more mundane registrar duties. The attention he received was also the envy of the other trainees.

As long as Sherlock was Andreason's protege, everyone gave him a wide berth, and the bullying was mostly limited to corridor talk behind his back. It simmered underneath the surface, until Andreason died, very suddenly. The funeral happened during Sherlock's two weeks of allocated summer holiday.

"Everyone knows what happens to a cub in nature when a lioness dies," Irene says coldly. "The vultures _rip it apart_."

Things escalated to a crisis point after a trainee by the name of Wilkes joined the program. He happened to know the Holmes family, having even attended the same boarding school as Sherlock in their teens, and he had no qualms about telling the other students about things Sherlock had desperately tried to keep hidden, such as his diagnosis of Asperger's Syndrome.

"Everyone has a breaking point. Holmes was quite tenacious, I must say, but having that thrown in his face proved the last straw. He had few defenders among senior staff; behind this lay the tensions created by Andreason during the years before Sherlock even arrived. I'd describe it as an unfortunate convergence of circumstance and his disability. The Deanery did what they could."

John seethes with rage, because it sounds like not much was really done to prevent the disaster, and even less was done by the higher-up after things began going wrong.

Irene seems to have read his mind. "Before you accuse us of negligence, you should know that it was Holmes who adamantly refused to get the Deanery, me, or even just the neurosurgical Program Director involved. He would not discuss the difficulties he was having with anyone, and one day, he simply didn't show up for work. His brother contacted the PD three weeks later to inform us that he was in a residential rehab unit."

Irene then summarises the rest of the story. When Sherlock returned to work six months later, something had changed radically about him, and this is when Irene had become more involved in the case, because instead of insisting nothing was wrong, Sherlock filed formal complaints against _everyone_. Suddenly, instead of continuing to be a timid person fumbling in his interactions, Sherlock unleashed an unprecedentedly aggressive mouth ready to belittle, insult and take down anyone who even dared to look at him sideways. And, the aggression wasn’t just verbal: he beat up his worst competition after a bar night, the likes of which he had never attended before, which made the whole thing seem premeditated. He verbally eviscerated the nurses who had been pushing him around, filed a complaint about a supervisor who had been hell-bent on trying to prevent him from advancing in his career. All in all, an ostrich had turned into a raptor—into the Sherlock Holmes that had made a big and not very favourable first impression upon his arrival at King's College.

Things settled down a bit after that, but according to Irene, Sherlock still elected to leave. While he was no longer bullied at The National, work there was hardly enjoyable or conducive to him finishing his training under the tutelage of the consultants, most of who intensely disliked him. Irene had offered to mentor him, but she naturally could not instruct him in his chosen speciality, and he declined such counselling and support. It helped that he was courted by several other units him after his shunt invention was introduced in conference circles.  No one could deny his skills, his brilliance, and no one dared argue with him anymore. But it wasn't enough to keep him at the National. The Baxter court case sealed the deal: the hospital board wanted to get rid of him as much as Sherlock wished to leave the National. A deal was made of a favourable recommendation letter and a phone call from Irene to King's College. Unaware of the court case and the details of his departure, King's jumped at the chance to recruit such a trainee.

John finds it logical that he would have wanted to leave even though the bullying had effectively stopped. Sherlock is skilled at projecting the image of someone who doesn't care at all what others think, but John has seen enough to know that this isn't the truth at all—quite the opposite. He'd lost his mentor and great defender, the one who saw his potential; left at the mercy of sharks, he had two options: perish or learn to bite back. _Offence is the best defence_ had obviously become his motto.

"The rest you should be telling me, and not vice versa," Irene concludes. "He reached consultancy, then?"

John shares with her a sanitised version of the last four years. Among details he leaves out are Afghanistan and the neck fracture.

Irene seems relieved to hear about the turns Sherlock's life and career have taken. "He showed great promise, and I always felt a bit guilty for not being able to do more. They involved me only after things had already escalated to a breaking point."

At the end of the meal, John thanks Doctor Adler profusely. She had not been able to do much back then, but maybe what she had decided to reveal today will come to some good.

  
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That afternoon, John calls Sherlock's secretary and orders her to direct the man to his office after his meningioma removal.

It has always been a delicate balance, a walk on a tightrope, trying to support Sherlock in managing his own interpersonal relationships but at the same time not demanding too much of him. They both know he sometimes uses the fact that John is both his spouse and his superior to smooth his path, to hide behind John's authority when he wants to avoid taking responsibility for something or doing things he finds arbitrary and boring at home or at work. He had been outstandingly supportive when John had been offered the position of Clinical Director even though it would raise him much higher in rank, and back then, John had had a nagging feeling that Sherlock has been thinking of the position simply from his own point of view—only taking it into account when it suits his own agenda. If that's true, then John really putting his foot down from that position for the first time will come as a shock. Still, that is what must happen if he's to keep Alice from crumbling under pressure. It will be a wake-up call for Sherlock that he has to decide what to do to break this log-jam, and John can only hope he manages to choose his words so that he won't be treated to the Sulk of The Ages. It's a risk he has to take since there are bigger things at stake here than just a tug-of-war over authority. Greg, who is Sherlock's immediate superior, is a great guy, but as the man himself would be the first to admit, John is the _Holmes whisperer_.

This time, whispering isn't going to be enough, though. What John needs is proper ammunition, and his position and what Irene has told him can provide it.

He needs to balance encouragement with making it clear that something must change.

   
  



	7. Lancing The Boil

 

"It isn't your habit to summon me like this. Usually, you come to the OR floor or the clinic to see me, or _text_ ," Sherlock points out without a preceding hello as he marches into John's office at two in the afternoon. Since he looks perfectly coiffed and tailored in his form-licking black suit and bouncy curls, he must have taken a shower after his long operation.

John forces himself to ignore the delectable sight. "Sit down."

"How official of you," Sherlock teases and sits in an armchair next to the window instead of the chair in front of the desk at which John is pointing.

John commands his own chair behind the desk. There's no beating around the bush today. "I'm issuing you an unofficial warning," John says sternly. "One which may turn into an official one, if the problem isn't addressed."

Sherlock is up from his chair like a flash.

" _What_!?" he exclaims before he has even engaged the full version of his best glare of signature indignation. After a few angry strides, John finds himself loomed over where he sits behind his desk.

"I told you something needs to change regarding Alice. This hasn't happened—if anything, things have escalated. If you continue not to address this, the warning will be official, and go in your records."

"You can't do this," Sherlock says, his tone outraged. "Not even Lestrade can issue an official warning just like that."

"You're right, he can't, not without approval from the Board—but the _Clinical Director_ can."

Sherlock's laugh is hollow and mocking. "You wouldn't. Why would you? That's preposterous."

"Preposterous would be assuming I'd play favourites and spare you of a fair and well-founded warning because we're romantically involved. I have no choice, Sherlock. You’ve left me none."

"Did she complain? Of course, she did," Sherlock snarls.

"No, because I think she's too intimidated and worried about her career to do such a thing. Others, however, have complained plenty enough that I have to take action."

"That's the hospital gossip mill. I thought the _Clinical Director_ would be above such poppycock."

John's mouth tightens into a firm line at this denial of the obvious. He knew this was never going to be easy, but a part of him had hoped he wouldn't have to use what he'd learned from Irene. It gives him no pleasure to drag any of that to the light, but he must hold on to the thought that there are bigger priorities here than the fact that Sherlock doesn't like people digging around his past.

"I’ve done what I would have to do with any other member of staff, and I'm also doing this to give _you_ no choice: either things have to change, or you have to start at least talking to either me or Greg about what's going on. And, what went on before that's got you in knots about this training thing."

Sherlock's eyes go wide. John can imagine him scrambling for a scathing retort, something to shake everyone off his tail. That's why John had gone to see Irene Adler; to be one step ahead of Sherlock, who is usually always three ahead of him.

 _Here goes nothing. No turning back now._ "I met with the UCL Program Supervisor. She says that your situation at one point was not unlike Alice's—as a matter of fact, you struggled much more than she does, after you lost your mentor."

"You don't know _anything_ about The National!" Sherlock exclaims, his face flushing with anger.

"I know enough to see that you had to either grow fangs or quit to survive!" John yells and stands up. "They called you _names_ , for fuck's sake!" Irene's recounting of the situation had not spared John from sordid details.

They are now standing inches away from each other. Sherlock can be intimidating at close range, but John can take him on, no doubt about it. Many an argument over the laundry rota and leaving pig brainstems in the bathtub has been won by The Command Stare and The Foot That Has Been Put Down.

Sherlock withdraws half an inch—1-to-zero for John.

"Some of those names were honorifics," Sherlock corrects him, crossing his arms. "For instance, because of my potentially income-generating invention, I was favourably described compared to those capable of creating rainfall."

John blinks. That doesn't make any sense.

"So there. It wasn't _all_ bad," Sherlock insists, but something in his pleading tone betrays to John that yes, it was precisely that bad and _someone_ is currently grasping at straws like a duck in a tsunami.

John pinches the bridge of his nose. It's not a good idea to burst Sherlock's bubble in an argument, but he desperately needs to understand from where all this misplaced rage and the knee-jerk reaction to eject everyone from his orbit comes. It's psychology 101, really, for someone to act out in a manner that was directed at them because they haven't been able to vent it out before, or because they simply never had a better model of how to act towards a trainee. It's still not alright. It's still not acceptable behaviour, and getting to the bottom of this might just do a bit of good for Sherlock as well.

"What. Did. They. Call. You." John breathes out.

Sherlock straightens his spine and looks him down his nose. " _Rain Man_."

 _Oh, for fuck's sake_. John is _not_ explaining this one to his spouse. He's not putting up with both a devastated registrar and a sulky Sherlock this week; he needs to keep this as positive as he can. He runs his palm down the side of his face. "Never mind that."

As usual, Sherlock has smelled something fishy. "What."

"I said never mind."

"John. _What?_ "

John needs to dive straight in if he's to get Sherlock to let go of that one. "I think that the way you are towards Alice has a lot to do with the way you were treated. You're letting your experiences and the need for vengeance to cloud your judgment, and that's ruining a young doctor's career."

"I can't fix her character flaws," Sherlock dismisses.

"Crumbling under extreme pressure from someone higher up in the hierarchy is not a character flaw. You had to get mean to survive, but if she doesn't do the same, it doesn't make her weak. Should we tell her to do what you did—shoot up, give you a black eye, tell everybody else to fuck off and get on with it?"

"Preposterous."

"Exactly."

"What I don't get is this: you obviously had an outstanding mentor for some time. Why not try to do things the way Andreason did?"

"Because no one should be allowed that much power over someone's career."

"What do you think should happen, then? Should we kick Alice out because her consultant won't train her? You think that's fair, tarnishing her career because of something that isn't her fault?"

Sherlock is silent, averting his gaze to look out the window with a huff.

John lets out a breath to calm himself down. He needs to avoid cornering Sherlock any worse, and he hadn't meant to mention the drugs. There had been suspicion of ongoing drug use after Sherlock returned to work from his holiday after Andreason died, but his urine sample had been clean so they couldn't prove anything. The fellow trainee who Sherlock had punched didn't want to report the incident, probably due to embarrassment, and eventually, the deal was quietly made that Sherlock would seek continued training elsewhere, leaving the National with a glowing recommendation that made no mention of the preceding drama. The hospital had a vested interest in not advertising his behaviour since the Baxter court case had already shed an unfavourable light on their training and employment practices.

Sherlock says nothing, his expression hard to read.

John leans a fist on his desk and regards Sherlock from under his brows. "Regardless of the reasons, I won't watch idly by while you become a fucking _bully_ just to get back at the universe for the way you were treated."

Sherlock snaps his jaw shut and his eyes turn to slits of fury again. "Don't you _dare_ call me a _––_ "

"If the shoe fits."

His reply is the slam of a door. John drops into his chair but gets startled when the door is violently torn open again, and Sherlock storms back in.

"No one ever gave _me_ a bloody break! They still don't! Every time someone needs to so much as talk to me, they summon you to stare me down! It should be beneath you, pretending to be some sort of a bloody minder or therapist or but _no_ , it's not enough that you're my superior, you undermine my authority at every turn by _supervising_ and _advising_ and _overseeing_! It's bloody tiresome, the way you're being used as a blast shield."

Sherlock rarely curses, and it's a wonder he hasn't already stormed out. John spreads his arms in surrender. "I agree. And, to stop that from happening when it comes to Alice you simply need to start taking responsibility for someone who'd be a great surgeon if she wasn't being held back and belittled at every turn by someone who should know what it's like to be subjected to such behaviour. It's no kind of an excuse that you weren't treated any better by your colleagues. Andreason didn’t do that to you, so why the hell are you doing it to Alice?"

Sherlock's lips are pinched tight in dismissive anger.

John isn't done. "What the hell is the point of continuing that cycle of destruction instead of just admitting that this is difficult for you? You're never going to get back at the people who have mistreated you, so wouldn't it be much better revenge to stop that shit, to _do better_ than they did? I know it's hard for you, harder than for most people, but you're brilliant, and if there are things you don't know, you always do the research, put in the work you need to learn more about dealing with people. I'm sorry some stuff I've done have come across as condescending, but please believe me: I have never doubted that you could be both the best of surgeons _and_ good with your patients. I wouldn't try so damned hard to help you if I didn't believe that. Just look at Alice. There's someone who's already great with people, now all she needs is for someone to help her be a great surgeon. You can do that, and one day, when someone asks how she got so good, she's going to say _because_ _Sherlock Holmes taught me._ I think that would be worth something, wouldn't it? She specifically wants to study under you because you're phenomenal, and she wants to be nothing less."

"This was never going to work," Sherlock snaps back. "You and Lestrade should have seen it, should have believed me when I told you. I knew it, so why do you have to hang onto some naïve idea of me suddenly sprouting all these skills I have always lacked? It's a waste of everybody's time."

John wants to tear out his hair. "A waste. A _waste_. You know what really is a waste? It's seeing someone who might become one of the best neurosurgeons in the world but whose skills will die with them. How many patients does a neurosurgeon operate during their career? Eight thousand? Fifteen thousand? That's nice, but what if that number could be multiplied? Teach what you know to someone, and they will pay that forward, and you've got tens of thousands, _hundreds_ of thousands of patients saved. That's a legacy instead of just a career."

"I just…If she's associated with me, and something happens, and I'm not there to make sure she––"

"Sherlock. You're not Jan Andreason, and Alice is not you. She's going to be _fine_. You will train her to be independent, and what happened to you won't happen to her."

"You think it's easier for her because she's not me. Because she's _normal_."

John draws a deep breath. "I guess. I'd be naive to deny that. But, it's going to be better for her also because the system here is not the way it was at the National. Even if you're the most important consultant for her, she works with lots of people during her training; there won't be a trench between her and the rest. Sounds like a part of that was Andreason's fault, not yours; you just ended up paying the price for his favouritism after he died. He taught you neurosurgery, but you can also learn from his mistakes in dealing with colleagues."

"You know I'm not good at learning from how other people behave because I don't know when their behaviour is the desired sort."

"Look–– Greg will reassign Alice to someone else if you ask him to. Alice won't make that request; she's clearly made of sturdy stuff and doesn't want to quit. Reminds me of you; you've said that plenty of people said that you shouldn't be a doctor, but you put in the work and succeeded. Can't you look at teaching the same way? You're not a quitter."

"Know when you are beaten," Sherlock mutters.

"Just stop trying to be a self-fulfilling prophecy and _try_. Nobody's asking you to be the world's nicest teacher; just stop deliberately sabotaging yourself."

"You know what happens to people who get involved with me; it makes them pariahs and wrecks their lives."

"That's the biggest load of crock I've heard! Look at _my_ career! A lot of it is thanks to you. What did I just say about a self-fulfilling prophecy?"

"You hate your career."

"I don't. I hate NHS bureaucracy, but the rest of it is just the way I want; I just had to take the long, hard road to realise that. And I most certainly don't hate my life; you're a big part of what makes it good; I wouldn't have any other version of you than the one I've got.

Sherlock looks sceptical. "Isn't your point that there is much that needs improving?"

"Well, some stuff, yes, but unlike you, I'm not throwing in the towel. Instead of letting bad patterns repeat, think about Andreason. Pay it forward, the good things he did. He helped you because he chose to see your potential instead of listening to everyone else. You're not cold or uncaring, not really—this just goes to show how responsible you feel responsible for other people."

John is beginning to realise that some of Sherlock's behaviour, as backward as it may seem, has been due to him wanting to protect trainees from going through the same he had; from their careers being so tied up to being in someone's favour that the loss of that mentor would make everything crumble to pieces. "You try to help people even when it's not your duty, and you heap guilt on yourself for things you haven't even done," John says quietly. He doesn't mention Victor Trevor out loud, but it's an obvious example. "You've convinced yourself that this training thing is some sort of rocket science. I bet Andreason wasn't God's gift to teaching, either, but he was a great surgeon and he wanted to impart that knowledge to someone. He chose you, and through you, Alice has chosen him as well. He's the reason she wants to be a neurosurgeon; she was his patient once."

John can practically see the cogs turning in Sherlock's head. Silence falls as he processes all this.

"I don't know how to make you and Lestrade understand that I really don't know how to do this," he finally admits. "You know I'm not good with people."

"I've never known you to accept a limitation that others put on you willingly. Don't put one on yourself. Can you honestly say that you've even _tried_? I know it's just easier to avoid it, but that just doesn’t match what I know about you. Nobody becomes a good teacher overnight. I may be a naïve idiot like you always tell me, but I know you, and I know you can do this. Just think about how you would have liked to have been treated and do that. All there is to it. We all had rubbish professors in medical school; just because someone is a highly regarded academic doesn't automatically make them a good teacher. There's lots of courses and workshops and literature about teaching available."

"Those are all written for––" Sherlock trails out, averting his eyes.

John can guess what he was about to say; they're words they both tend to avoid. Maybe it's time to stop doing so. "Yeah, probably not a lot has been tailored for someone on the Spectrum. But, that just means we'll have to work a bit harder, to search until we find a source or approach that's more tailored. Which is what we should have done to start with, but I doubt you would have been amenable. Alice is paying the price for that, but I really think we can fix this."

"You said that I intimidate her. I can't just suddenly erase that, can I?"

John certainly doesn't have a quick fix for this, but surely any chance for the better could help Alice feel more at ease? "A part of helping someone grow a proverbial pair should be to help them acquire the knowledge and the skills that give them a natural sort of authority? You learned to stand up for yourself; maybe she could practice that with you, once we get the two of you on the same page," John says with a smile.

"But what if something happened and she was left without a supervisor?"

"Every trainee faces that risk, but it very rarely materialises. What happened to Andreason was the worst of luck, and I'm so sorry you had to go through that, but I doubt you'll be keeling over from a coronary and leaving Alice without a consultant anytime soon."

Sherlock still looks sceptical about it all.

John walks around his desk to get closer to his partner, placing a hand on his shoulder and giving it a squeeze. "I know it must've been tempting to let this prove to everyone that you're not fit to be a teacher so that you wouldn't have to put up with the responsibility. But why let people think less of you than you're actually capable of being? I'm not mad at you, but just like Greg, I am responsible for you _and_ our trainees. I want to _help you_ , but you need to let me do that, and give Alice a proper chance. You can do this, love. _I know you_ , and you can do this. The fact that Alice specifically requested you—even after hearing all the corridor talk about what you're supposed to be like—means that she is probably willing to accommodate a lot."

Sherlock sighs, averts his gaze for a moment. He still looks like a deflated balloon. "You don't know how to help me with this, nor does Lestrade."

"Then we'll find someone who does. Do you want to walk away from this and say you never even tried, so you failed, and you shouldn't ever do it again, or do you want to be the Sherlock I know who keeps defying everyone's expectations?"

Their eyes meet, and Sherlock seems to study him for a moment. Slowly, his apprehension is replaced with a pale imitation of what looks more like his usual strutting confidence. "Alright, but then _you_ have to do something about Harry."  
  


-o-0-o-0-o-0-o-0-o-0-o-0-o-  
  


He does need to do something about Harry. Of course he does.

After psyching himself into a state in which he was capable of taking the initiative for Alice, John decides he should make use of that to make some decisions at home. The atmosphere in the flat isn't getting any lighter; it's clear that Harry's has no motivation to stop drinking as long as she manages to convince herself she deserves the indulgence. Her repeated excuse is that she is 'in mourning'.

"Mourning is for people who have actually lost something, not for people who are serial self-saboteurs of relationships," Sherlock had told her two days ago.

"You ever lost anybody, then? No deaths in the Holmes family as far as I remember, so how are you such an expert on this?" she had asked him in a mocking tone.

Sherlock had stopped, hands on hips, to glare at her; he had been on his way to the music cabinet in the sitting room. "I did lose someone recently who was important to me. And I nearly lost John. Where were _you_ when that happened? Lovingly tending to a cheap bottle of scotch, I presume."

Harry made a fumbling clamber up to perch on the sofa cushion, her big toe poking through a worn sock. "I wasn't there, because you wouldn't have wanted me there, anyway! I always tell John everything, but the two of you never tell me stuff that happens."

She had a point; several months passed from their return from Afghanistan until John had picked up the phone and told Harry what had happened. Sherlock had once mentioned that he'd tried to call her from Brize Norton before boarding a military flight to Kabul, but despite three attempts, she never answered.

"And therein lies the problem," Sherlock had snapped at her, "the world is so full of your drama that there is no space for anybody else," he announced, grabbed his violin and retreated to the bedroom.

Harry scoffed, watching him go. "What crawled up his arse?"

 _You_ , John had almost blurted out. "Don't talk to him about that sort of stuff."

"What stuff? He was talking down on me. I don't have a right to defend myself?"

John pinched the bridge of his nose. "Just don't tell him he doesn't understand how other people feel."

"Sore spot?"

"Yeah, kind of." He didn't want to get into this in more detail; Sherlock wouldn't want him to. After they had moved in together and Harry had met Sherlock for the first time, John had disclosed to her that Sherlock is on the Spectrum after she had—uncharacteristically carefully—asked why he was so "odd". She doesn't seem to understand much about it, and John doesn't want to give her more reasons to dislike him—or, God forbid, opportunities to tease him about that stuff.

"He's got lots of sore spots, doesn't he?" Harry said thoughtfully. "Must be a minefield, being with him."

John had taken Sherlock a mug of tea and got treated to a vivacious and angry rendition of a Pergolesi concerto. When he returned to the sitting room, Harry was watching some game show or other, for which John joined her. For a moment, he imagined that she was just visiting, that they were some other people, people without Harry's problems, a sister and brother who could just sit like this, enjoy each other's company, have a glass of wine together without everything being so bloody complicated.  
  


-o-0-o-0-o-0-o-0-o-  
  


In the afternoon, Sherlock meets up with John at the staff garage. Neither of them mentions the conversation they'd had earlier, and John is relieved that Sherlock doesn't appear to be bristling over it. He does seem quiet on the drive back, but not any moodier than usual. Stopped at a crossroads, John pats his knee and gets a smile.

When they get home, the flat is empty. Luxuriating in the sudden privacy, they take over the sitting room sofa for a brief rest, Sherlock stretching across it and placing his head on John's lap while reading a scientific journal that's come in as part of the day's mail.

John leans his head against the backrest and considers having a glass of port now that it won't tempt Harry. Then again, Harry hardly needs triggers to go for the bottle.

He doesn't want to ask Sherlock to move, though. Carding his fingers through the curls on his lap, he skims the page Sherlock is on. _"A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection and survival"_ is the headline.

"A resection of at least 98 % of the volume of a tumour gives patients up to five months longer a lifespan than resection of less than that," Sherlock summarises. "But, before I believe a word of this I have to have a look at how they made that percentage estimate in each case since the surgical margins of glioblastomas are notoriously difficult to define," Sherlock muses.

John twists a lock around his fingers, and Sherlock swats away his hand. "Tickles, stop it."

This brings a chuckle from John just as his phone rings. Sherlock gives him an indignant glare in protest as John reaches out to grab it from the coffee table, making him turn his head.

"Hello?"

"Johnny?  Can you get me out of here? Someone's just grabbed my wallet! Just like _that_!"

"Well, they don't usually ask for permission," John finds himself joking, even though Harry sounds quite frantic. It's not the first time she has ended up somewhere in a state where stealing from her would be like taking a lollipop from an infant.

"I'm in Soho," Harry complains. "My Oyster card's in the wallet, too."

"Get a cab; I'll meet you downstairs."

"There's some stupid festival here, they've cordoned off the whole thing. John, _please_! Can't you come get me?"

John groans and Sherlock's eyes flit up to meet his, brows hitching up into an inquisitive look.

"You've got your phone. Try Uber," John suggests.

"They could be serial killers. John, come _on_! I just got robbed, for fuck's sake!"

 _Harry?_ Sherlock mouths. John rolls his eyes and nods.

"Can you get to the St Martin-in-the-fields car park?" he finally asks, gritting his teeth.

"Yeah, maybe, yeah, I think so. Thanks." Harry rings off.

It's six in the evening. Driving downtown will be a nightmare, but maybe they could pop into a restaurant. "I need to go get her, someone's nicked her wallet. Want to come with? We could grab dinner on the way back."

"Conference call with Nick in Edinburgh at seven," Sherlock says. Nick Sergeant is a neurosurgeon who is the Scottish contact person for Sherlock's shunt study. "Sorry," he offers.

"It's fine."

Sherlock lets him up, and John goes to find his car keys.

During the drive, he has time to think whenever he's not cursing a suicidal cyclist or trying to circumnavigate roadworks.

During the past few months, he has learned that he can't just let things slide into disaster and blame other people. The things he chooses to do or not do have consequences, and he has to face them instead of wrecking relationships trying to avoid owning up to those repercussions. If he lets Harry stay, she and Sherlock are eventually going to be at each other's throats, and John will have to keep choosing sides. He should be choosing Sherlock's, but Harry knows how to push his buttons and force him to defend her. He ends up constantly playing peacemaker when he should be confronting her about her behaviour instead.

This has gone on for too long, this thing where he tries not to enable Harry but ends up doing so anyway, since she's so good at playing the sister card. She had been tremendously talented at convincing him that no one should expect much from her, considering where they come from, that she's a victim of circumstance. John used to believe her; used to believe that since the debacle of their parents' marriage had been their only model of a long-term relationship, they were both probably destined to fuck up their own and that it was best not even to try. " _Men_ ," he remembers their mother cursing. " _They're all the same. Not you, Johnny, I raised you right, but the rest. Can't live with them, can't live without them_." No attempts were ever made by their parents to resolve their issues, to really listen to one another. Their father's drinking would have made it impossible even if other things hadn't already been in the way. A drunk person's self-awareness is an oxymoron.

It had taken a long time for John to address these beliefs about himself with Molly, but address them he had, and it had given him the last puzzle pieces he'd needed to understand what had gone wrong with Sherlock before and after his injury. He had believed, deep down, that any success he finds in his career and relationships are lucky accidents—sand castles which could crumble at any time—so it doesn't matter if he messes them up; they were destined for failure, anyway.

Isn't that making the same mistake of which he has just accused Sherlock: believing something negative about oneself, then making it come true to fulfil the prediction?

 _Commitment issues_ , Molly had written on her pad once about John. It had felt like such a cliché, but doesn't it apply to Harry as well? That whisky is her only successful long-term relationship?

John knows it's an illness; there's a diagnosis number for it. He knows that when it's gone on for as long as it has with Harry, she probably won't be able to crawl out of it on her own. But, if Sherlock can do it—and he kicked a bloody speedballing habit—because he had been motivated to do so, then Harry must have a chance as well.

Arriving in Soho, John finds her where they'd agreed to meet. She's still rattled but not very inebriated. During the drive, she chatters away about this and that, mostly complaining about people John doesn't even know. He hates it when Sherlock tunes him out, but now he is very tempted to do the same to her.

When they get home, Harry tries to slink off to the shower, but John tells her to sit in the kitchen instead.

"Sherlock? Could you come in here?" John calls out, and the sound of typing from their bedroom stops. Since the study has been taken over by Harry and Sherlock can't concentrate on work in the sitting room when someone else than John is in the vicinity, he has begun taking his laptop to the bedroom.

"Calling for backup?" Harry scoffs, crossing her arms.

Sherlock emerges in his shirtsleeves, looking slightly put-upon for having been interrupted. "Yes?"

"I was wondering if you might consider extending Harry a loan."

"What?!" Harry exclaims.

Sherlock raises a highly sceptical brow. "Explain."

"The money wouldn't go to her directly, but to pay for rehab at one of those posh places, the sort where you went to." John doesn't shy away from mentioning Sherlock's past drug issues in Harry's presence since they both tend to mention them quite openly. She's the only one besides John with whom Sherlock is willing to discuss any of it. Their relationship is not warm by any standard, but they are both forthright people, and sometimes they project a camaraderie surrounding this topic that John finds slightly disturbing.

"She'll pay you back once she gets back on her feet, finds a job and all that," he promises Sherlock.

"I don't even have a flat! I can't go off to some clinic; I've got stuff to do!" Harry protests.

"Stuff you're clearly not doing. And which you won't do, as long as you don't care about anything else than your next fix," Sherlock points out.

"Look who's talking," she points out, but the protest is quite feeble. "Besides, those places are for rich people. Have you any idea what they cost?"

"Sure," John points out. "Which is why you should put your nose to the grindstone and make the most of it. And, while you're there, try to sort out a flat and some job possibilities. We'll put your stuff in storage and pay for it, but you're not coming back here."

Finally, for the first time after appearing on their doorstep, Harry actually looks like the truth has sunk in. "John––"

"I'm doing this because you need me to."

"I don't _want_ you to! You're a bloody doctor, aren't you supposed to serve the good of the people and give them what they want?"

"A good physician is not like a salesperson who has customers," Sherlock points out. "A customer is best served when they get what they want, which isn't necessarily what they need. A doctor is obligated to treat their patients in a manner that's medically justifiable."

"You must be glad, getting me out of your hair," she accuses, glaring at Sherlock.

"Leave him out of it," John scolds her. He feels bad, lecturing someone who had looked after him when he'd been little, read him bedtime stories under two blankets to try to drown out the sound of Dad and Mum fighting, but they can't go on like this. "You're going. Either out the door, with your stuff, or to somewhere nice to get better. Your choice. People have always given you what you want, and that's precisely the problem. I help you, you ask for more, you make an even bigger mess of things, I pity you, I help you some more, and the damned loop goes around and around and around, and it won't stop until your liver, or your pancreas gives out or you decide to make some sort of a change."

John notices two bottles of expensive, small brewery wheat ale on the kitchen table. When Harry's ran out of money she goes for the cheap stuff; lately, she's simply been adding stuff on their Ocado order since she doesn't have to pay for any of it.

"Shouldn't _you_ be the one to lend me the money?" Harry asks John.

"If it were me, you would try to slither out of it, and unfortunately I just might let you. So, it's got to be someone who will _not_ lend a sizable sum of money and let it slip away without getting paid back."

In truth, Sherlock is not very interested in what happens to the impressive amount of money his shunt invention has earned him, doesn't invest or manage it in any way. John is the one who sorts out all their daily finances. But, that's none of Harry's business.

"The only time I really need your help––" she starts complaining.

"You always need my help. It's never going to stop, until you start respecting yourself enough to start helping yourself. So, what's it going to be?"

Harry slumps down to a chair by the kitchen table. "It's not like I've got much choice, have I?"

A floorboard creaks as Sherlock shifts his weight. "I will have a list of potential facilities in thirty minutes."

 

 

**Notes for the Chapter:**

> I have no idea about the disciplinary procedures for NHS staff, so artistic licence has been employed in the details of this chapter.


	8. A Fresh Start

 

It is already two minutes past the end of Doctor Pichler's prior appointment, so Sherlock gives her office door a sharp knock. The moment the door opens, Sherlock strides in and gets right to the point: "How does one train someone? How does one keep them from becoming too reliant on instruction? How can their independence and self-reliance be cultivated? What if I fear that association with I might taint their reputation?"

A man who he suddenly realises must be Doctor Pichler's previous patient is still sitting on the sofa with their eyes wide doing a double take.

Sherlock's breath hitches in his throat. He now stands frozen in the middle of the room, realising that he must have been so distracted that it hadn't occurred to him that someone might be in the room still, in addition to the doctor.

  _Ah._ _I've done it again, whatever it is that startles people like this_.

"My apologies," he suggests slowly, wondering if it's the right thing. He studies Doctor Pichler's calm, slightly amused expression, and can't decide if he finds it reassuring or not. Though she should be surprised by his appearance, she is concealing it well.

The psychiatrist's attention returns to the patient on the sofa. "I'll see you next week, George," she offers with a smile, having recovered control over the situation.

Sherlock, however, is now wringing his hands with both the urgency of his inquiry and the crushing defeat of having been, well, _himself_ , again. _Unaware. Clumsy. Upsetting of other people_.

He watches the other patient— _George, was it? Is he on the Spectrum?_ – leave. Doctor Pichler closes the door after him.

"I apologise for the intrusion," Sherlock offers again. He has already apologised once; was it not satisfactory? Why has he not received a reply?

"It's fine. We were merely practising some small talk at the end of a session," she replies amicably. "I wasn't expecting you; I hope I've not got my appointments mixed up."

"I've not reserved one. I don't need therapy, I need advice, and I hope we can move on to that now, instead of wasting more time."

He had known that the psychiatrist has an opening right now in her schedule; her receptionist had admitted to as much. He hadn't _booked_ the appointment because he isn't a patient, he just needs very specific counsel.

The psychiatrist points to one of two armchairs placed by a window, but Sherlock crosses his arms and remains standing.

"I just need to know how to create a positive feedback loop conducive to learning that does not involve despicable Pavlovian conditioning, create overt dependence on childish positive reinforcement or, most importantly: ensuring that the manner of mentoring does not make the subject of it too vulnerable to changes in whoever it is that is educating them."

"Please, take a seat. This conversation will last long enough to warrant it, and it will make your discussion partner more comfortable if you do so." The psychiatrist points to the sofa close to her desk. Sherlock pats it first, making sure George has not created an uncomfortable indentation in it.

She takes a seat behind the desk. "Your questions would probably be best answered by an educational expert, not a psychiatrist," she suggests, but there is a challenge in her tone, and she looks interested.

 _Good_.

"My particular issues must complicate such matters, which is why I am asking _you_. I have already perused a formidable collection of educational literature, and everything even remotely pertinent I could get my hands on was geared towards educating _students_ on the Spectrum. There is _nothing_ useful available regarding situations where it is the teacher who––" he trails out, frowning, suddenly surprised at his reticence to say the words out loud. Doctor Pichler _knows_ he's on the Spectrum, that's why he's here, that's why John was here, and they've discussed it––

Suddenly, it occurs to him to wonder whether he should inform Alice of his diagnosis. _What a horrid thought._ This is exactly why he needs to know how much of a complication him being who he is will be for her training.

He squeezes his thumb between his forefinger and his middle finger. _Do I need to tell her? I don't want to tell her. I didn't even want to tell John._

"You are quite right; not much has been written about this. Many academics on the Spectrum actively seek a career in research instead of an educational role. Many give lectures, of course, but I assume we are discussing something more practical, such as being someone's academic supervisor?"

"I have been forced to sign on a Specialist Registrar."

"Forced?"

"I would have preferred to avoid such an engagement, but our Clinical Director does have a point in my skills dying with me unless I teach them to someone else. Little future benefit from my particular talent will be preserved unless I mentor someone. There is logic to this, but I lack the know-how to deliver it."

"So, even though you are reluctant, you have decided you do want to make an effort to do this well?"

"Yes; so I have been persuaded,"

"I'm not sure if I can give you very concise advice right away. I would have to know more about you and the student to do so. I try to avoid generalisations, and in a matter like this where – as you said – there is little evidence-based material available, it's particularly important to tailor my advice."

"I will not engage in therapy. I've had enough of it; it has been mostly useless, oppressive, or both. I don't _need_ therapy; I need a consultation for specific educational advice. Preferably, you would be available when needed for such counselling. This needs to work on a need-by-need basis."

"I respect that, and if you have been subjected to approaches before which have been aimed at forcing you to conform and suppress traits that are important to your well-being, then I am truly sorry on behalf of my profession. But, as I told you, giving advice would require for me to assess you. Storming in here and demanding answers and making a hasty escape when you think you've got them is not how any kind of a therapeutic relationship or even just counselling works, Sherlock. It is just a way for you to try to keep the ball completely in your court."

"I don't understand sports metaphors."

"It means that it's an avoidance strategy, not allowing me to do my work properly."

He scoffs. "I'm not avoiding anything—I'm here, aren't I?"

"To perform a surgical operation, you need the right tools. The same applies to psychiatry. I cannot make recommendations without tools: knowledge of you and your trainee. It's a good idea for any teacher to have support in their work. It can be intense, taking on such a responsibility. While I would naturally be employing my expertise as a psychotherapist and psychiatrist, you may think of it as coaching the coach: me helping you to help your trainee."

He relaxes a little. She has caught the plot. "Exactly. Tailored advice. I'm not saying this would be on a regular basis, but––" he trails out, hoping that she would make a more concrete suggestion since she still seems to have some reservations.

Doctor Pichler looks thoughtful. "I would suggest we meet for six appointments, after which I will be at your disposal whenever you feel that there is an issue regarding your professional relationship with your trainee. How does that sound?"

"Why six?"

"It takes a few appointments for a counsellor and a client to become familiar and comfortable with each other. I suspect it may take longer with you since you are obviously suspicious of anything that reeks of therapy. The fact that you are here is a good thing, but it doesn't mean that you're willing to tell me things right away which I would need to know."

"John only saw you twice."

"We had some very specific issues to discuss, and he had already built a constructive therapeutic relationship with Doctor Hooper. I could say that John was primed to be able to get right to the point, and we were mostly not discussing him; it tends to be easier to talk about other people than it is to look inward."

“You were discussing _me_."This brings his knee-jerk reaction out in the open. "I accept your terms but reserve the right to terminate this whole thing at any point."

The doctor smiles at him. "Of course. That is every patient's right; if it turns out that you are not comfortable with me, I will recommend another ther–– _professional_."

Sherlock glares at her. This will not be _therapy_. He doesn't need such a thing. He just wants _advice_. "I doubt I'd be willing to go through this again with anyone else."

"Alright. I'll just have to be on my best game, then," Doctor Pichler says. She may be joking, but the humour doesn't sound malignant. It doesn't sound as though it's directed at her, but Sherlock cannot often be sure he has analysed such things correctly.

Sherlock leans against the backrest of the sofa, expectant but wary.

Doctor Pichler grabs and a pen and a pad. "Tell me about this trainee, then. Off the top of your head, what worries you the most right now?"

Before he had walked into this room, his worries had been a vague sort of unease, a sense of dread. Now, those thoughts have redirected themselves. It's as Doctor Pichler has just phrased it: instead of focusing on other people, he is looking inward. "Do I have to tell her?"

"Tell her what?" Her tone is light, and it irritates him. It must be a deliberate attempt to defuse his anxiety, and it's not working.

"Do I have to be explicit to my trainee about the primary reason I am in need of advice?" he counters, proud of himself for not falling for such obvious verbal entrapment.

"Sherlock, what diagnosis did they give you as a child or adolescent?"

The one time he had discussed this with John, such concrete, clinical terms had felt safe. Now, they feel like a finger pointing at him. Why? This is why he's here. This is why he is consulting this particular person.

Minutes pass, and Sherlock can't bring himself to reply.

"Sherlock, you have the right to decide what terms are used about you by others who are not medical professionals when discussing these matters. But, I need to know. I need my scalpel, my retractors and my forceps just as you do. But, they're all just tools, meant to be wielded by a trained, educated person who sees the big picture."

"Can't you just answer my question?"

"Short answer: no, you do not need to disclose your medical history to a trainee. It is your private matter."

"Is there a longer answer?"

"It seems likely that you need to have a conversation with her about finding it challenging and intimidating to take on her training. But, there are many possible ways to discuss your particular challenges, to focus on solutions instead of problems, and I will help you prepare for that discussion. Acceptable?"

"Yes. Very."

She lets an expectant silence descend, since it is very obviously his turn, now.

 _Quid pro quo_. He had demanded her answer first, and she had relented, but now he needs to do his part. He likes that the psychiatrist had explained why she needs to hear certain details from him; that diagnoses are just tools, not the whole truth. He knows this as a physician who had passed his compulsory psychiatry course, and it's ridiculous that he needs such reassurance. They're just words.

He uses this sudden frustration to loosen his tongue. "Some experts were of the opinion that I have Asperger's syndrome—which is now becoming obsolete as a separate entity, of course. Some suggested atypical autism, but in those days that category was still mostly reserved for non-verbal children with more profound developmental deficits. I think the consensus as I approached adolescence was some manner of general developmental deficiency with borderline autistic features."

"If you went through that diagnostic process now, do you think those diagnostic possibilities would be contested?"

"No. The diagnostic criteria and terminology have changed, but I doubt the result would be anything else than the Autism Spectrum."

He doesn't want it to matter when it comes to Alice, but it always matters. Whenever he needs to deal with other people, it matters, regardless of what people call it.

But, Andreason hadn't cared. He never asked why Sherlock kept getting into conflicts with patients and other staff. As long as he fulfilled the man's expectations in the OR and sorted out his clinic and ward duties, everything was fine. Andreason taught him to operate, but when he died, Sherlock realised that the _other_ skills one needs to be a good surgeon, he still lacked as badly as he had upon graduation from medical school. 

Then John appeared, and things finally started to change.

John's words: _'You can do this, love. I know you, and you can do this._ '

"Thank you for telling me," Doctor Pichler says.

Such praise is childish, of course, and it shouldn't make him feel this pleased about himself. He places his palms on his knees, straightens his back.

The psychiatrist flips a page on her notepad. "So," she continues, "Tell me about this trainee, then."  
  


  
-o-0-o-0-o-0-o-0-o-  
  
  


On a Saturday morning, John gives a very hung-over Harry and her one suitcase a ride to Kings Cross station. They grab a coffee since her train for Edinburgh since there's still time before her train leaves.

After googling through the list compiled by Sherlock—which had excluded the place John knows he had gone to—she'd picked a private unit called Abbeycare Scotland.

"If I've got to go through this shit, better do it in a proper castle, eh?" she had joked, and John had forced out a smile.

It will cost quite a lot. Not enough to create a sizable dent in Sherlock's funds, but still. They both know that there's a high risk of relapse, and an even higher risk that Harry will never be able to pay every penny back, but not once has Sherlock voiced the possibility and demanded any guarantees. John had asked him for the money because it needs to come from someone else than a brother; it's been proven time and time again how he'll relent when she asks for something. From Sherlock's perspective, the issue probably seems simple: John had asked him to do this important thing, so he'd said yes.

"Sherlock says they'll take your phone away for some time, but you can write letters," John suggests.

"I bet they make you write some shite apologies to everyone, like AA."

John chuckles. Most likely, such letters from Harry would be as darkly hilarious as they'd be difficult for her to write. It's not the Watson way, talking about things, dragging emotions out to be examined. But, to make it through life without messing everything up, that pattern needs to be broken. John had done it with Molly's help; now, it’s Harry's turn.

"Just––keep in touch, alright?" John says. He would have expected the tension in their flat to get worse after his announcement to her that this was it, that sending her to rehab would be the last thing he would do for her unless she got her shit together. But, to his surprise, things got a lot easier, leading him to wonder if it may have even been a relief for Harry that someone else had taken over the decision-making.

John can relate to that. He had been terribly resistant to seeking help until he'd accepted that he didn't have to work things out alone, that he wasn't a failure for not being able to change certain things about himself. All he had needed was some expert help. He consults colleagues at work all the time when his own knowledge and skills aren't enough; why had it been so bloody hard to admit that same thing when the patient was himself?

It has often been said that doctors make the worst patients. John understands, now, what that means.

"I'm not a bad person," Harry says, stirring her freshly pressed orange juice with a straw.

"I know."

"I just––sometimes I just don't want to think about any of it. I just want to let go."

"You can't let go all the bloody time."

This is why Harry thrives at the start of a relationship—she gets doted on, someone else provides the flat, the food, everything. She relishes the lifestyle, seeing no need to care about her drinking and the way she never lasts in any job. She's wonderful, she really is—why else would people like her so much?—but she's impossible to cope with when the sandcastle begins to crumble.

"How about trying to be on your own for a change, after they discharge you?" John suggests.

"Why would I want to be alone?"

"To see that you can do that."

"I know I can."

"When have you ever?" John asks.

"Hmm." She sucks on her straw.  
  


-o-0-o-0-o-0-o-0-o-  
  
  


After Harry departs, Sherlock is quiet for a few days. Not brooding, exactly, but thoughtful and distracted, playing the violin into the early hours of the night instead of coming to bed.

John has refrained from mentioning the conversation they'd had in his office; he wants to give Sherlock time to process, to decide what to do. He also doesn't want to discuss it at home of all places, wanting to keep home life and his professional role separate. At home, they should be equals.

On Monday, Sherlock texts him without an explanation that he won't be carpooling home. In the evening, after arriving home two hours after John, he pushes his dinner around the plate, and John can easily spot his nervousness and distraction.

Finally, Sherlock puts down his fork and tells him that he has sought what he calls _outside assistance_ with Alice. This assistance turns out to be Doctor Joanna Pichler. John is happy that his partner has picked the ASD-specialised therapist; every time John had relayed a piece of advice he'd got from her or recited a comment she had made, Sherlock had always listened intently and often seemed to agree, if not very verbally.

Sherlock being on the Spectrum will probably never be a topic they can discuss casually at home, but it's a good thing if he can talk about it with someone. He tells Sherlock as much, and it's the end of the conversation. He's tempted to ask if Sherlock has a plan on how to start changing things, but he doesn't want to stack more pressure on his partner.

A few hours later, lying in bed, John once again listens to the late-night violin playing, trying to guess what the selection of music is saying about Sherlock’s mood. He tends to only go for more modern pieces when something is bothering him; that's when he wants serious technical practice with which to distract himself, to put some distance between what he is feeling and the music.

Tonight, John doesn’t mind being kept awake by the nocturnal concert, because half the ORs are closed due to a surgical conference in the AHSC—the Academic Health Services Centre, a partnership between three NHS Foundation Trusts, namely Kings, Guy’s & St Thomas and South London and Maudsley—so Sherlock won't have his outpatient clinic to attend tomorrow.

In the morning, they end up having tea in bed since neither of them needs to be at the hospital early due to the morning meetings being cancelled. So, it’s a sedate start.

"What’s on your schedule?" John asks as they start making their way from the staff garage to the hospital. He's hoping for a joint lunch, which might be a chance to test how Sherlock is feeling.

"I'm heading down to the OR," Sherlock says, but instead of going to the locker rooms to change, he appears to be going there in his suit. "And I would appreciate backup."

This makes John curious enough to trail along eagerly. "Sure."

Sherlock leads them to the observation area of neurosurgical theatre number three—the only one currently open due to the conference closures. A case is underway, requiring a trans-sphenoidal approach. John is surprised that Sherlock would be interested in such an operation; there are other surgeons in the unit who handle most of them, including Anderson who is listed as the one in charge of this particular one, with Alice assisting. Trans-sphenoidal surgery means operating through a hole created through the back of the nose and the sphenoid bone behind it to gain access to the pituitary gland.

Alice and Anderson are standing on the same side of the patient's head, peering into two sets of eyepieces connected to the large surgical microscope covered with sterile drapes.

Standing beside Sherlock, watching quietly, John realises that it's actually the other way around than what he had assumed—Anderson is letting Alice operate, and is assisting himself. Sherlock is watching the proceedings, worrying his lip, hands clasped behind his back. The scrub nurse glances at spectators but doesn't alert the surgeons to the fact that they have an audience.

Alice leans her pinky on the Sugita frame that is keeping the patient's head immobile, squares her shoulders and begins extracting a long endoscopic instrument from inside the skull. In its grip turns out to be a pea-sized tumour, hanging like a piece of firm snot. She drops it into a formaldehyde-containing pathology sample jar offered by the supervising nurse and then places the instrument onto the expectant hand of the scrub nurse. Surgeons may switch the instrument set to an uncontaminated one after removing a tumour to avoid spreading malignant cells into healthy tissue.

The microphones aren't on so John and Sherlock can't hear what is being spoken, but judging by his gestures, Anderson is explaining something to Alice who refrains from requesting another tool of their trade so that she can listen. The atmosphere in the OR looks relaxed, and a glance at the monitors tells John the patient is stable and under deep general anaesthesia, as they should be.

Anderson is soon handed a tiny, delicate bipolar electrocauteriser and Alice a similar instrument based on ultrasound. They do some further work on making sure that not even the smallest of vessels in the area are bleeding. Once they are satisfied with the surgical field's bloodlessness, they begin closing up.

John knows Sherlock must be evaluating every tiny movement, every passing of instrument from hand to hand, every decision made and the overall speed of the proceedings. Judging by the thousands of surgeries John has seen, he knows that Alice has just performed a flawless tumour extraction from the sella turcica, a small bony saddle deep in the skull. It is not something a neurosurgeon would be likely to let a trainee do unless they were very convinced of the trainee's skills. John, and especially not Sherlock, would never claim Philip Anderson is a particularly good neurosurgeon, but he is a cautious and responsible one. Allowing a registrar to take the lead in such a case must mean that Alice is up to the challenges the field of neurosurgery poses.

Fifteen minutes later, Anderson holds the patient's head while Alice removes the Sugita screws. The patient is then repositioned on the operating table so that their head is being supported by a plastic slate and a pillow, and the surgeons trail out of the OR.

When they walk past the observation area, Sherlock clears his throat and interrupts Anderson's animated explanation of the intricacies of frontal sinus vasculature.

"I'd prefer it if you stopped filling the head of _my_ registrar with your likely outdated nonsense, Philip," Sherlock says equably. "Alice, a word, please."

John isn't sure what Sherlock expects of him. Had he just wanted company to watch the surgery, or does he want a third participant in this conversation? "Do you want me to––" he starts asking.

Sherlock glances at John. "I suspect Alice would prefer it if you stayed."

Alice now looks fearful, her gaze sweeping from Sherlock to John, who tries to look disarming. She has no idea what this is about, so she might be even worrying about the termination of her contract.

Anderson skulks away, leaving the three of them in the quiet spot between the corridor and the washing area.

Sherlock crosses his arms, but instead of dismissive, he looks slightly apprehensive. "Alice, I… It has been brought to my attention––" he starts awkwardly, clears his throat again, glances at John and then swallows, "that some of my––interactions with you may have proven detrimental to your work performance and education. You should know that your level of competency has been, by all accounts from those who have observed your work during the past few weeks, very satisfactory."

"Thank you," Alice says tentatively. There almost seems to be a question mark at the end. She must be bewildered as to where this is suddenly coming from after months of hardship.

Sherlock looks through the window into the OR which is being cleaned, then shifts his gaze back to Alice. "While it might be the easiest option to terminate our educational relationship, I wonder if you might be willing to give it another try. The decision is wholly yours and saying no will lead to no negative consequences; I will arrange the matter with Doctor Lestrade."

Some of what Sherlock is saying sounds rehearsed, calculated even, carefully formulated beforehand, but that is hardly a bad thing. It means that Sherlock has given this some thought; perhaps he's had help in planning what to say.

Alice is silent; John suspects she is seriously considering the option of making her life easier by walking away. But, she is also someone who had wanted to be trained by Sherlock even though she likely knew from rumours and corridor talk that it wouldn't be easy.

"I presume that saying yes would require some reassurance that things would be different," Sherlock suggests.

Alice nods.

Sherlock points to the bench placed by the back wall, and the two of them take a seat while John remains leaning on the frame of the door leading into the OR.

"I would like to suggest that whenever you feel I may have crossed a line, and you feel uncomfortable about addressing it verbally, you may give me a note explaining the event, and I will seek to amend my conduct. I will not question your critique, nor will I comment on it afterwards. The notes will not be shared with anyone else at King's." Sherlock sticks his hand into his jacket pocket and produces a pad of bright fuchsia Post-It notes. "Please detail why the particular incident upset you; don't assume I will be able to deduce it."

Alice receives it, looking bewildered.

John realises Sherlock has just built a loophole; technically, his choice of words will allow him to discuss them with John at home, and with Doctor Pichler. It's clever, but then again, coming from Sherlock such an idea shouldn't surprise John.

"I do not know how to be attentive to the emotional needs of others, so you may need to turn to other colleagues such as Doctor Watson here for that kind of support."

John smiles at Alice and gets a nod in reply.

Sherlock isn't finished. "I will not be soft on you. I will not help hide your mistakes, many of which you will make because that is what happens to everyone early in their careers. What I _will_ do, however, is to pass on to you what I know and am capable of, so that you may build on that. I will also do my utmost best to remove any and all obstacles from the path of a career that has all the makings of a great one: namely, yours. But, you will have to work harder than the idiots filling the rest of the registrar spots in this programme. Don't be tempted by the allure of _good enough_ ; otherwise, you'll end up like Anderson who lowers the IQ of the entire theatre floor."

Alice sticks the post-it notes into the breast pocket of her scrubs. When Sherlock suddenly stands up, she hurries to stand up as well.

"Do we have an agreement, or do you need time to consider my suggestion?"

Alice stares at him, shell-shocked, but then seems to snap out of it and nods. "No, Mister Holmes––I mean, yes. I'd like to try again, very much so," she replies with more confidence than John has ever witnessed from her in Sherlock's company.

Sherlock's stiff posture softens just a bit, and to John's astonishment, he offers his hand to Alice to shake. "In that case, I think you might start calling me Sherlock."

 

-o-0-o-0-o-0-o-0-o-0-o-0-o-

 

Two weeks later, John goes to the theatre floor as a courtesy morning visit. He often does this during his admin days, but today he's is particularly keen to have a peek at how things are going between Sherlock and Alice. As far as he's heard, things have started to go if not exactly well, then at least significantly better between their moodiest neurosurgeon and their likely most promising registrar. Sherlock seems to try to be very conscientious about his new line of thinking regarding teaching her, and she doesn't seem as intimidated by him anymore. He hasn't shared the contents of any of Alice's Post-it notes with John, but they are clearly important to him: he tends to read them in the car and take a picture of them, after which he googles things and types up notes of his own on his tablet. He probably discusses them with Doctor Pichler, and the trickle of notes seems to be slowing.

"Hold the door," Alice calls out to him just after John has opened the theatre floor door with his keycard. She is carrying a small cardboard tray of plastic cups with covers. It's not the first time John has seen her returning from an Italian-run café a block from the hospital.

"I'm not sure I like the fact that he still sends you on a coffee run," John says.

"If it keeps him happy, I'm fine," Alice tells him as they make their way to the break room. "I think of it as an ice-breaker."

"In that case, throw in a biscotti when he's in a bad mood. He's got a sweet tooth," John replies just as Sherlock strides in through the door.

His eyes had turned into suspicious slits even though hasn't even heard John's words. He must have already deduced from John's conspiratorial grin that they were discussing him. Sherlock shares half his mocha with John while Alice changes into scrubs and rereads the patient notes for their afternoon surgery.

Three hours later, John takes his sandwich to the observation area of OR number four, where he finds Sherlock and Alice peering into the opposite horns of a surgical microscope. He signals to the supervising nurse to turn on the sound in the observation area and to turn one of the screens so that he can also see the view from the surgical field camera inside the microscope. He quickly recognises the landscape as the bottom of the Circle of Willis—the convergence of arteries looking after the brain, located near the bottom of the skull. They're in the process of clipping an aneurysm.

"Instead of pressing down, imagine that you're scooping under the artery," Sherlock explains. "That way the connective tissue won't tear but stretch, and you won't end up leaning so much on the vessel that you'll compromise distal circulation."

Alice hums in reply, and John realises that she’s the one advancing through the tissues towards the handling the aneurysm on screen, not Sherlock. He's assisting: holding a tiny retractor and a pair of forceps with a cotton swab to keep the field as bloodless as possible.

John knows Alice has been allowed to operate more, but for Sherlock to let her handle a cerebral aneurysm repair is nothing short of jaw-dropping.

"I checked on Beth Winnicott this morning, like you asked," Alice says. "The partial paralysis of her right hand is gone; just as you said, it seemed to be caused by just swelling. And, the path report's come back; it was a DIPG."

A Diffuse Intrinsic Pontine Glioma is the second most common type of highly malignant brain tumours in children. In many cases, surgery is not possible, and since many drugs used to treat high-grade tumours in adults won't work on DIPGs, radiation therapy is the only option in many cases. Ninety per cent of children diagnosed with this type of tumour pass away in less than two years after diagnosis. Beth Winnicott may not have many symptoms now, but the tumour will grow back.

"Just as I feared. Unusual presentation with a seizure. Usually, they affect balance, facial muscles, vision or limb function. Has a referral to the paediatric oncology team been made?"

"All sorted. And, I thought it best also to involve the child psychiatry unit. There's a meeting with the family scheduled at two in the afternoon where they'll hear the news. We'll be done by then?"

"We should be, yes, and shall both attend. I have also asked Marie to join us; she has met the family at the clinic. You would do well to observe how she interacts with patients and families."

As the consultant, it will be Sherlock's sombre duty to tell the parents the dire prognosis. John is glad he doesn't seem embarrassed to involve his outpatient clinic nurse in such discussions; it's obvious they've built a good working relationship regarding patient communication.

John hadn't gassed for the Winnicott case, but he remembers Sherlock talking about it in the car—a very small child with a large tumour. John recalls the conversation in the car because Sherlock had been wondering out loud things in which he never seems to be interested: what it's like for a parent to lose a child and why people would have children when there's a risk that they might have to go through such an ordeal. John had no answers for him, especially since he had to focus on traffic. Even though Molly has helped him immensely with what he now recognises as PTSD, driving through noisy construction areas sometimes still puts him on edge.

On the other side of the glass wall, the two surgeons continue their attempt to save another patient's brain.

"Now, which clip would you select if you were closing off a more saccular form?" Sherlock asks.

"Depends on the aetiology," Alice replies. "For mycotic, I'd want to clip not the neck but isolate as much of the surrounding vessel wall as I could."

"Excellent. If only Anderson had learned that as well," Sherlock quips, and John spots a slight grin on Alice's features under her mask.

John gapes. That was an actual bit a _praise_ Sherlock has just lavished. _Imagine that._

"Now, why do you think it's particularly pertinent for a surgeon to learn about the saccular ones?"

"Because a larger percentage of them cannot be coiled angiologically."

"What about fusiform?"

"There's no stem, so rupture is much less likely."

"There are no current guidelines as to what size fusiforms ought to be operated on, but my personal opinion is that they could be monitored far beyond the usual cut-off limits, especially since isolating many of them from circulation will inevitably lead to infarction. Good of you to join us, John."

John blinks, then presses the microphone button. "You haven't even looked up, and I haven't said anything."

"Footstep sound patterns. You're not wearing theatre footwear but your leather shoes, and I recognise your steps. It's the small things, John, always the small things. Yesterday I knew you'd been in the elevator I used moments before, because of your distinctive aftershave and the fact that your deodorant had failed."

The scrub nurse shakes her head with a smile.

"Gee, thanks for telling everyone that," John scoffs, but doesn't attempt to conceal his own grin.

 

-o-0-o-0-o-0-o-0-o-0-o-

 

When the challenges of interacting with Alice begin to trouble Sherlock him less and less with Doctor Pichler's help, another worry begins to plague him more.

This family-starting issue is weighing heavier on him than he would ever have thought. He finds his thoughts creeping to it when his brain is not otherwise occupied. He watches John in shops, out on the town, in the car and at the hospital whenever there are children around. He looks for signs, without knowing what they are. How could he tell normal, courteous interaction from something speaking of a hidden longing? It hangs on him like a cloud, this… _thing_ , this not knowing. He does not know whether he has the right to deny John something like this—whether he could be enough that John would forgo all that and stay with him.

Why does there always have to be something that's his fault that threatens their union? It's tiring. It's depressing. It drags him down. He solves one issue in his life, and another pops up like a game of emotional whack-a-mole.

He's so tired of it, tired of being tripped up by his own defectiveness, tired of lying awake with more questions than answers. Confronting John about a difficult issue has worked at least once before to resolve it, but on that one occasion it had slipped out like water when Sherlock had been too upset about the halo to rule over his faculties with his usual iron will.

Maybe he is fit to train someone. Perhaps Doctor Pichler is right, and he wouldn't ruin their offspring. It's good, knowing now that perceived incompetence is no longer a confounding factor. But it's still a separate entity to the fact that he does not want children.

He is _denying_ John something, and he feels guilty for it.

John, who he suddenly realises has grabbed his arm and is shaking it, blue eyes heavy with worry and alarm.

Sherlock's surroundings begin registering. _Ah_. They had been heading for the produce section of the supermarket, but instead, he has wandered to the aisle housing baby supplies and toys. No wonder John looks so...weirded-out, for lack of a better word.

"Earth to Sherlock," he says, "we were supposed to get brie."

"Do you want this?" Sherlock asks urgently.

John's hand stops, slides off his arm. "What? Brie?"

"Children."

John chuckles, then glances around. "Um."

"Um _what_?" Sherlock demands.

John looks like he hasn't even understood the question.

"Do you, or do you not, want offspring of your own, either adopted or genetically yours?"

A bearded, thirty-something man reaching for a packet of nappies gives them a wary glance. Sherlock gives him a death glare as a preventative measure. He finds that recent parents often have a strange compulsion to enforce their opinions on others when it comes to the supposed bliss of child-bearing. That reallyisn't something he would welcome right now—or ever.

"Can we just go get cheese?" John asks.

Sherlock expects a shadow to move through his features during this attempt at closing down the dialogue, but John looks as carefree as ever. Yet, Sherlock knows he can't let himself be relieved by this. Maybe John just doesn't think the issue is imminent in their lives yet, but one day it might be.

Sherlock curls his fingers around the handlebar of their shopping cart and refuses to budge.

John scratches his temple. "Is there any point in me asking where this is suddenly coming from?"

"Irrelevant."

"Right. So. No, not really. I mean, I've thought about it, but it's never felt like something I'd actively want to do."

During his weeks on mulling over this, Sherlock thinks he has devised the perfect litmus test for picking apart not actively wanting something and willing to adjust to it. "Had you ended up together with a woman, and they became pregnant, how would you have reacted?"

"Well, not with instant joy, that's for sure. I think I would have had quite a hard time adjusting to the idea. Maybe the notion would have grown on me, but I don't think I'd ever have suggested it. But, love, this is so, so pointless because I'm _not_ with a woman."

"No. Which makes starting a family a more conscious choice since it cannot happen by accident. But not impossible. There are ways––"

"I have a family: I've got you, I've got Harry, as much as she drives me nuts. I like our life; I like that we can travel and have some quiet time at home, just the two of us. Kids are fine as a concept, but I can honestly say I've never actively wanted one, never _wanted_ to be a parent."

"You're nearly forty. That could change."

John shakes his head, smiling. "If it does, I'll let you know, and we'll deal with it. I'd actually say that approaching forty is more likely to mean that my opinion has stabilised. It's women whose chances start dwindling at that age."

"I am perfectly well-versed in human reproductive endocrinology."

John claps a hand on his shoulder. "I know you are. Let's get you equally well-versed in the cheese selection on aisle twelve."

 

-o-0-o-0-o-0-o-0-o-0-o-0-o-

 

**ONE MONTH LATER**

****__  
Murdostoun Castle, Whishaw, Scotland  
October 12th 

_Hey bro –_

_Yes, they do make you write these rubbish letters, so you're getting yours. I thought I might get two for the price of one so say hi to Sherlock for me as well. And thanks, I guess. It's lovely here unless you count all the stuff they make you do. I tried it, talking I mean, I don't know if it works, but it doesn't make things worse._

_I don't know how or why to apologise. Life's been shit, apart from sometimes when it wasn't. All this looking back at things isn't really very me. I'm sorry if I disappointed you, maybe it makes you feel better to know that you're not the only one. You've done well. You did really well with what we had. I don't know if I have any of that in me, but if I try, then I hope I've got you to cheer me on._

_I'm going to stay until the end of the program. They said to invite you over for the Family Weekend, Sherlock's not going to want to come, I know, but if you fancy a weekend in Scotland (in a castle!!!), then it's the 1st to 3rd of November. Would love to see you. Maybe talk. You'd like it here. It's not like that horrible inn Mum took us to with Gran. It's probably not anything like the places Posh Git takes you to, but anyway, it's beautiful here._

_Love you._

_Harry_

  
John pockets the letter, opens the lid of his laptop and starts searching for British Airways flights to Glasgow.

 

-o-0-o-0-o-0-o-0-o-0-o-0-o-  
  


**TEN MONTHS LATER**

During a Friday night, someone tacks up a printed copy of a scientific journal article on the notice board in the break room of the neurosurgical OR unit. It has been published in Annals of Neurosurgery, a prestigious publication, and the headline is ' _A Novel Approach to Intraoperative Local Cytoreductive Therapy in Anaplastic Astrocytomas_ '. While it boasts a formidable list of eleven authors—most of whom have not even set foot in the OR and have merely provided some background resource or other for the greater purpose—it is the very first two names that are significant, them being _Lowe, Alice_ _M_ and _Holmes, W. Sherlock S_.

****

 

 

**_– The End –_ **

   
  


**Notes for the Chapter:**

>   
> 
> 
> Doctors Holmes and Watson will return later this year.
> 
>  


End file.
